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TO THE 



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DISTKICT OIF COLUMBIA, 



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THE 

ABNER WELLBORN CALHOUN 

MEDICAL LIBRARY 

1923 



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PRESENTED BY 









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MEDICAL AND SURGICAL ESSAYS,. 



HEI'OHTED TO 



SURGEON GENERAL WILLIAM M. WOOD,. 



UNITED STATES NAVY. 




PUBLISHED BY ORDER 0^ THE NAVY DEPARTMENT, 
WASHINGTON, D. C, 1871. 



WASHINGTON: 

GOVERNMENT PRINTING OFFICE, 
1871. 



CONTENTS. 



Page. 

Practical Suggestions in Naval Hygiene. By Albert L. Gib. on, M. D., 
Surgeon, U.S. N 1 

Resection of Head of Femur for Gunshot Wound. By W. E. Taylor, 
M.D., Surgeon, U. S.N 110 

Remarkable Course of the Bullet in a Case of Gunshot Wound of the 
Abdomen. By Albert L. Gihon, M. D., Surgeon, U. S. N., United 
States Hospital Ship Idaho, Nagasaki, Japan 123 

Comminuted, Depressed, and Impacted Fracture of the Skull; Tre- 
phining Sixty Hours after the Injury ; Recovery. By Albert L. Gihon, 
M. D., Surgeon, U. S. N., United States Hospital Ship Idaho, Na- 
gasaki, Japan 126 

Case of Death from the Bite of an Unknown Venomous Insect. By 
Albert L. Gihon, M. D., Surgeon, U. S. N., United States Hospital 
Ship Idaho, Nagasaki, Japan 131 

Stricture of the Urethra ; Retention of Urine ; Rupture of the Urethra 
by the Patient's Attempt to Introduce a Bougie ; Recto-Vesical 
Puncture ; Sloughing of nearly the Whole Integument of the Abdo- 
men and Penis, and of Two-Thirds of the Scrotum ; Perineal Sec- 
tion; Variola; Pysemia; Recovery. By Albert L. Gihon, M. D., 
Surgeon, U. S. N., United States Naval Hospital, Portsmouth, New 
Hampshire ; 136 

An Account of the Yellow Fever which appeared in December, 1866, 
and prevailed on Board the United States Steamer Jamestown, Store 
and Hospital Ship at Panama. By Delavan Bloodgood, M. D., Sur- 
geon, U. S. N 144 

An Account of the Epidemic of Yellow Fever which appeared on 
Board the United States Steamer Saratoga, in June, 1869. By 
Lewis S. Pilcher, M. D., Passed Assistant Surgeon, U. S. N 172 

Sanitary Condition of the United States Asiatic Squadron, during the 
Period of Two Years, from April 1, 1868, to March 31, 1870. 185 

On Diabetes. By James McClelland, M. D., Medical Director, U. S. N. 192 

Case of Erosion of the Entire Penis. Reported by W. S. W. Ruschen- 
borger, M. I)., Medical Director, U. S. N 204 



PRACTICAL SUGGESTIONS IN NAVAL HYGIENE. 



By Albert Leahy Gihox, A. M., M. D., Suegeox, U. S. N. 

REPORTED TO THE BUREAU OF MEDICINE AXH SURGERY. 



Philadelphia, October 1, 1871. 
Sir : I beg leave to submit to your consideration the follow- 
ing suggestions of it code of sanitary regulations for the Navy 
of the United States. The preliminary remarks on the various 
subjects, that come within the scope of naval hygiene, are 
intended chiefly for medical officers who have just entered the 
service. Since their professional education is presumed to 
have been completed, I have not considered it requisite to 
repeat facts that are fully elucidated in works on physiology, 
nor even to discuss the general principles of hygiene. I have 
merely attempted to show that the peculiar circumstances of 
life on ship-board, to which they are as yet strangers, do not 
necessitate a violation of all the laws of health. 
Very respectfully, your obedient servant, 

ALBERT LEABY GIHOX, 

Surgeon, United States Navy. 
William Maxwell "Wood, Esq., M. D., 

Surf/eon General, United States Navy, 

Chief of Bureau of Medicine and Surgery, 

Navy Department. 



CONTENTS 



• Page. 

I. The province of naval hygiene 3 

II. The examination of recruits 5 

III. The receiving-ship 17 

IV. Navy-yards 20 

V. Humidity 26 

VI. Ventilation 32 

VII. Light - - 41 

VIII. Clothing 43 

IX. Personal cleanliness 46 

X. Food 49 

XI. Potable water 61 

XII. Sleep i 69 

XIII. Exercise 72 

XIV. Climatic influences 73 

XV. Moral influences 85 

XVI. The sick-bay 97 

XVII. Sanitary regulations for the Navy 102 

XVIII. Sanitary regulations for transports 107 



NAVAL HYGIENE. 



THE PROVINCE OF NAVAL HYGIENE. 

Notwithstanding the general knowledge of the fact that the 
better mode of relieving human flesh of the ills to which it is 
heir, is to prevent them, very little is done toward lessening the 
amount of physical suffering among mankind. ISot only are 
individuals improvident of health, but public communities neg- 
lect precautions that would avert many attacks of disease ; and 
even governments, having control of armies and navies, are 
unmindful of preventive measures which would diminish the 
expense and promote the efficiency of these bodies. 

It ought to be unnecessary to urge the importance of naval 
hygiene. If it be so requisite to study what to do and what 
to leave undone on shore, where everything demanded for the 
healthy maintenance of the body is in abundance, how much 
more strictly ought the laws of health to be observed on board 
ship, where human beings are crowded together in violation 
of all these laws, breathing a scanty supply of air vitiated by 
the retention of their own excretions, subsisting upon an un- 
wholesome diet, their sleep always interrupted, and their minds 
continually disquieted by passions called into operation by the 
unnatural circumstances of their lives. Yet no sanitary code 
has ever been promulgated in our own service, nor until recent 
years has it been attempted elsewhere. The young medical 
officer is without a guide. As much confused by the manners 
of those around him as by the maze of rigging overhead, he 
credits whatever he is told and accepts "it as the custom of 
the service" as palliating whatever appears barbarous and 
unnatural. 

The same cause that has retarded the influence of civil 
hygiene, has prevented the institution of sanitary regulations 
for the Xavy. The real character and mission of the physician 
have not been recognized. He is regarded solely as a medi- 
cine man, and there is a general rebellion against his authority 
when he prescribes to the well what they shall eat and drink, 



4 MEDICAL AND SURGICAL ESSAYS. 

how they shall live, dress, and sleep, how their Louses should 
be built, their lands tilled, and their food cooked. The public 
mind does not rise to the comprehension of the extent of pro- 
vince of our great profession. The scientific medical man is 
at most regarded as an "allopath," a sectarian amid globulistic 
and rational homoeopaths, Thompsonians, and Swedish move- 
ment curers. 

The naval surgeon has had his domain still further retrenched. 
Despite the radical changes which time has effected in the 
service, there are still many who affect a deafness to his 
warnings through a fear lest the medical officer transcend his 
position. Traditional jealousies and want of confidence have 
been perpetuated. Some narrow-minded officers, cherishing 
this feeling of caste, use their powder to resist what they pre- 
tend to consider encroachments upon their jurisdiction. Over 
the country are distributed the victims of this system, and 
many a grave has been untimely filled through inattention to 
sanitary recommendations. Every national vessel arriving at 
our naval sea-port brings a number of invalid men and offi- 
cers ; the business of the naval hospitals is disproportionate to 
the size of the naval establishment ; and this sacrifice of life 
and money will continue "until physicians have the place in the 
councils of military commanders that is due to science. The 
health history of the late wars in Europe is demonstrative in 
proof of the important fact that military life has been sacri- 
ficed in an enormous proportion to ignorance — that is, to the 
unwillingness of commanders to be advised on subjects which 
they could not themselves be supposed to know." — (Robert 
Jackson.) " From the neglect of the precautions specified, 
thousands of lives have been sacrificed which might otherwise 
have been preserved. The care of the health of the troops 
should certainly be one of the first duties of a military com- 
mander. Unless his men are in good physical condition they 
can be of no service to him in carrying out the ends he may 
have in view, but are a hinderance to him and a burden to 
themselves. And yet how often it happens that those in com- 
mand are heedless of the warning and inattentive to the advice 
given by their medical officers."— (Hammond.) " It is urgently 
necessary that the influence of enlightened medical opinion be 
more and more felt in the administration of the Navy in all 
matters relating to health, for costly blunders still continue 1o 
be committed in the construction and arrangement of our 



MEDICAL AND SURGICAL ESSAYS. 5 

ships of war, which seriously injure the efficiency of the crew 
and which might be easily effected if every ship were thoroughly 
examined by a sanitary officer before she was commissioned. 
One of our ironclads, the Royal Oak, was found to be a most 
unhealthy vessel from first going to sea, and thrice had she to 
be inspected by a sanitary board before her high sick-rate was 
reduced. And this is but one of many similar instances that 
might be adduced." — (Medico-Chirurgical Review.) 

The naval authorities of Great Britain and France have 
already acted toward the establishment of sanitary codes. The 
medical officers of our own service, therefore, would be delin- 
quent in delaying longer to obtain the sanction of the Depart- 
ment to their recommendations, and that indorsement of 
authority which will secure their observance. In this let us 
disclaim any purpose of interference with any other corps. 
Cheerfully recognizing our obligations of obedience to the com- 
manding officer and constituted authorities, we have no desire 
to do anything that is foreign to our calling as physicians. The 
sacred character of our profession bestows such honorable and 
enviable distinction and dignity upon its followers, that we 
need not seek to encroach upon the functions of others. We, 
therefore, demand that our motives in making these sugges- 
tions may be uo longer impugned, but that our efforts to accom- 
plish the legitimate objects of our vocation may be generously 
assisted by the other corps, that our common aim, the honor 
and efficiency of the service, may be attained. 

THE EXAMINATION OF RECRUITS. 

The province of naval hygiene begins at the recruiting office. 
To banish disease from ship-board as effectually as possible, it 
is as necessary to guard against its admission within the bodies 
of the officers and men themselves as to prevent its develop- 
ment among them, just as the attempt to extirpate the syphilis 
of the public prostitutes of large cities is fruitless so long as 
men, who are themselves affected, are allowed access to them. 
Hence the importance of carefully guarding this avenue to dis- 
ease. With the medical corps rests the entire responsibility of 
selecting the personnel of the navy. The various grades of 
officers are examined prior to appointment by special medical 
boards, while the medical officer of the rendezvous is charged 
with the examination of all applicants for the subordinate posi- 
tions of shipped and enlisted men in the Xavy and Marine Corps, 



C 3IEDICAL AND SURGICAL ESSAYS. 

and with the rejection of all who are unfit for these branches 
of the service, whether on account of existing - acute or chronic 
disease or deformity, or constitutional taint, infirmity, predis- 
position or inheritance, physical or mental. Could this duty 
be always performed with rigid exactness,' sick-lists would con- 
sist only of acute maladies and injuries ; but, unfortunately, all 
the cachexia? are represented on our medical returns. Many 
of these latent seeds of disease are hidden beyond the ken of 
the most acute observer ; still there is reason to complain of 
the superficial manner in which these examinations are often 
conducted. It is not unusual for a man discharged with a cer- 
tificate of ordinary disability from a naval hospital to reappear 
at that hospital within a few weeks, either from the receiving- 
ship or from some vessel to which he had been transferred and 
found unfit for duty. A second discharge has been followed by 
reshipment at another station. Most of these cases wait until 
their arrival at a foreign port, and then present themselves 
with chronic and incurable maladies, for which they have to be 
invalided, and sent, at great expense, to a naval hospital in 
the United States, perhaps the very one they had left. There 
are men who have passed years in the service in this way, 
without having ever completed a cruise. Hiemorrhois, prolap- 
sus ani, fistula', reducible hernia?, stricture of the urethra, func- 
tional cardiac diseases, syphilis, and chronic rheumatism are the 
complaints which are most frequently thus alternately concealed 
and reported. It is not presumed that all such cases can be 
exposed at the rendezvous, but greater care and minuteness of 
examination would reveal many of them, and the establishment 
of dynamometwc tests would discover the greater number, as 
well as convalescents from exhausting diseases. Thus, it would 
have prevented the shipment of a man with chronic luxation of 
the head of the humerus, whom I have encountered three or 
four times in the service, and who, while able to perform the 
usual movements of the shoulder-joint, could not accomplish 
violent circumduction without displacing the bone. Dr. Magru- 
der, of the Iroquois, now fitting at the Philadelphia navy- 
yard for a cruise in the East Indies, informs me that he has 
had to transfer to the hospital, with phthisis pulmonalis, a 
recruit whom he found to have been surveyed and discharged 
from the service only eight months prior to his reshipment ; and 
states that there are two other cases of incipient phthisis and 
one of the developed disease already on his list, although the 



MEDICAL AND SURGICAL ESSAYS. 7 

ship has been but a few days iu commission. A few years ago, 
a man who bad recently shipped was discharged from the New 
York Naval Hospital with double inguinal hernia, which he 
confessed to have had five years ; and among a list of forty-seven 
cases of pulmonary tubercle then in the hospital, (1SG0.) twenty- 
three had been in the service but a few weeks, and in most of 
these there was not a doubt that the early stages of the disease, 
or the tendency to its development, was positively indicated at 
the time of shipment by local physical signs or by evidence of 
constitutional impairment. Chronic rheumatism and subluxa- 
tions are more difficult of detection, but even these can seldom 
perfectly dissemble all the abnormal actions of their articula- 
tions. 

As a further check to the admission of disqualified men into 
the service, it is necessary to particularize descriptive lists, to 
specify and locate exactly every ineffaceable mar, scar, or pecu- 
liarity of the individual, and to describe more fully and accu- 
rately than is now done the general appearance and develop- 
ment of each person. This complete descriptive list should 
accompany the man throughout his connection with the service ; 
when transferred from one vessel to another; when invalided 
and sent to a naval hospital ; when discharged from that hos- 
pital, whether on certificate of ordinary disability or to duty ; 
when discharged from the service, whether with ordinary or 
honorable discharge ; and it should appear on all certificates of 
disability, death, or pension. In all cases of discharge for per- 
manent disability from incurable affections or injuries, it should 
be filed at the Navy Department for reference when suspicion 
is entertained that such a man has reshipped, and as evidence 
against him, if this have been done, on his trial for the fraud 
he had perpetrated upon the Government. Men should also be 
instructed to preserve these lists carefully as conclusive and 
requisite for their identification. A recent instance within my 
own knowledge illustrates the necessity for minuteness and 
exactness in descriptive lists. Jeremiah Griffin presented him- 
self at a rendezvous to ship as coal-heaver, and was refused by 
the recruiting officer on the ground that he had already shipped 
and had failed to repair on board the receiving-ship. This he 
denied, and reference to the surgeon's register, although estab- 
lishing the prior shipment of Jeremiah Griffin, coal-heaver, of 
the same height, age, and nationality as the applicant, exhibited 
in the column of remarks, " defective teeth," while the man 



8 MEDICAL AND SURGICAL ESSAYS. 

then offering had a perfect set. Incompleteness of descriptive 
lists subjects the Government to fraudulent claims. John 
Smith, boatswain's mate, shipped and presented an honorable 
discharge on -which he claimed three months' extra pay. He 
was well marked by the loss of a portion of a finger, but no 
mention was made upon the discharge which he presented, of 
the deformity, which had existed a long time. The sale and 
transfer of honorable discharges is readily carried on when de- 
scriptive lists are merely filled up with " eyes dark, hair dark, 
complexion dark, marks none," or " eyes light, hair light, com- 
plexion light, mark on arm ;" and furthermore, the interests of 
the man himself are often jeopardized by his name not being 
spelled in conformity with the original shipment, or by careless 1 
ness in transcribing the meager items of description. I have 
known Houghton, after only two years in the service, to return 
as Horton, Bacquiel as Boquil, Tuer as Ture, and Koulousi as 
Gulachi, and afterward as Galusha; transformations which 
originated, perhaps, on board the receiving-ship, where some 
careless or uneducated clerk, in making out the roll of the crew 
to be transferred to a sea-going vessel, spelled by sound, or as 
well as he knew how, the names as they were read to him, and 
committed an error which may appear under a second mutation 
of form on the honorable discharge, filled up in a similar man- 
ner by another equally heedless clerk. Even should the man 
present himself for reshipment at the same rendezvous where 
he originally passed, the very medical officer who wrote the first 
descriptive list must perpetuate the error on the second to se- 
cure the sailor his three months' bounty, since its payment will 
be refused unless the reshipment agrees in name exactly with 
that on the face of the discharge. Instances of this are numer- 
ous. One related to me by Surgeon Kitchen occurred in 
January of this year, (1871.) A very worthy and intelligent 
petty officer named Charles L. Anthony, having refused to sign 
his name on reshipment Charles T. Anthony, as it had been 
erroneously entered on the books of the ship to which he had 
been previously attached and thus copied upon his honorable 
discharge, was, in consequence, refused the payment of the 
bounty to which his long and faithful service entitled him. In 
my own experience, Peter Woppel, as an honorable discharge 
styled him, though he protested that he was baptized Vaupel, 
and so wrote it in a legible hand, had to remain a Woppel 
until some other blunderer- might convert him into a Wobble or 



MEDICAL AND SURGICAL ESSAYS. 9 

something else, his claim for admission iuto the Naval Asylum, 
after twenty years' service, consequently being invalidated 
under the rule requiring that service to be under the same name, 
or great difficulty being occasioned in the adjustment of any 
pension claim in his favor. As it devolves upon the medical 
officer to fill up the blank descriptive list with the name, nation- 
ality, &c, of the recruit, it behooves him, for the sake of being 
exact, to cross-examine closely the answers that are made on 
these points. Many men, who profess to have been born in 
New York, Boston, or Philadelphia, will, when asked the pre- 
cise place of birth, mention Cherry, North, or Penu streets, 
localities not remarkable for the fecundity of the females who 
dwell there. This is done through a fear lest only natives of 
the country will be accepted, or in the belief that it will insure 
them more favorable consideration ; but when assured on these 
points, they frankly admit that they are of foreign birth. Con- 
fusion often arises from the number of identical names on board 
ship. I have seen a John Smith 12th. The most of these 
are simply "purser's names," and a little coaxing and argu- 
ment will usually induce the man to acknowledge his proper 
name, and in other cases will reveal a middle name, which is 
seldom tendered unless asked for. Foreigners should be re- 
quired to spell their names in their native languages, since it 
will often happen that a man may be designated Louis Klauc 
or Johau Schmidt, who would otherwise have become a numeri- 
cal Lewis White or John Smith. Not unfrequently common 
English names are spelled incorrectly by the examiner himself. 
Since writing the above, I was in a rendezvous where I observed 
a young assistant surgeon enter the name of a recruit without 
asking the orthography, and to my inquiring how he knew that 
to be the proper spelling, he replied, " Oh ! I judge so." Thus 
Thomson is given a p, Emory an e, and Eraley an i, merely as 
the indolent or indifferent examiner may judge proper. How- 
ever acute he may be iu other respects, no exercise of judge- 
ment will enlighten him whether Eiley or Eeilley, Dixon or 
Dickson, Wallis or Wallace, Fife or Fyffe, Sheppard or Shepherd, 
Diehl or Deal, Bailey, Bayley, or Baillie is correct. All this care 
on the part of the medical officer, however, will be thrown away 
unless the Government exacts a rigid adherence to the original 
returns of the rendezvous in spelling and every other particular, 
by every person whose duty it is to transcribe those returns. 
How readily could the applicant for re-enlistment, or the chronic 



10 3IEDICAL AND SURGICAL ESSAYS. 

invalid, who, as soon as sent on board ship and required to 
do duty, repairs to the sick-bay with a sprained back, a strict- 
ure of the urethra, or a rheumatic joint, be identified, if his 
descriptive list were filled up in some such manner as follows: 
John Henry Smith, seaman; native of Galway, Ireland; age, 
when shipped, 20^ years ; height, 5 feet 6J inches ; figure 
slender ; hair, brown and curly ; complexion florid, face square, 
forehead low, nose sharp, mouth small, teeth perfect, eyes dark 
chestnut aud sunken, broad cicatrix of scald on left shin, 
anchor on right hand, &c. All this involves a little more labor, 
but it is labor that the Government has a right to demand of 
its officers. The subject is so important that I have been 
induced to dwell upon it at some length. Every act of duty, 
however trivial, should be well done, and professional pride 
shoidd deter every officer, whatever bis rank, from affixing his 
signature to a subordinate's work until he has satisfied himself 
that it has been performed entirely free from mistake. The fol- 
lowing list of errors in the descriptive lists of the crew of a 
single vessel, (the St. Louis,) effectually illustrates the mag- 
nitude of the evil sought to be corrected: 

Isaac J. Borden, age 39 ; instead of Isaac G. Borden, age 31. 

Petrie Martin, age 29 ; instead of Pierre Martin, age 40. 

William Prene, native of Hartford, Connecticut; instead of 
William Pram, native of Maryland. 

William J. Heme, native of Maine; instead of William J. 
ffearne, native of Canada. 

Alfred McDonald ; instead of Alexander McDonald. 

Randall McVerrish; instead of Ranald McVerrish. 

William Sims ; instead of William Syms. 

Alexander Gorman; instead of Alexander (P Gorman. 

James Rolen ; instead of James Noulean. 

George McGoyn ; instead of George McGoyne. 

Christian Allvord ; instead of Christop Allvorden. 

Frederick Linderman ; instead of Frederick Lendman. 

William Channer ; instead of Wiliam Charmerin. 

Daniel Callihan, native of Rhode Island; instead of Daniel 
Callaghan, native of New Tori: 

Cornelias Callighan ; instead of Cornelius Callaghan. 

Peter Durgan ; instead of Peter Dugan. 

Monroe Durgan ; instead of Monroe Durgin. 

John Custice ; instead of John Curtice. 

Charles J. Conlogue ; instead of Charles J. Conologue. 



MEDICAL AND SURGICAL ESSAYS. 11 

Andorous Dodge; instead of Andorus Dodge. 

Ayusius McEweu ; instead of Angus McEwen. 

Benjamin A. McClain • instead of Benjamin A. MeClane. 

Charles H. Smith, age 25, native of Denmark; instead of 
Charles H. Smith, age 22, native of Providence, Rhode Island. 

John Kelly, native of Brooklyn ; instead of John Kellj', native 
of Philadelphia. 

John Brown, native of Ireland ; instead of John Brown, native 
of Boston. 

Henry Johnson, native of Russia ; instead of Henry Johnson, 
native of Prussia. 

George Brown, native of Nova Scotia; instead of George 
Brown, native of New Hope, Pennsylvania. 

John Williams, native of Sweden ; instead of John Williams, 
native of Pennsylvania. 

Andrew Anderson, native of Philadelphia ; instead of Andrew 
Anderson, native of Norway. 

Patrick Fardy, native of Maine ; instead of Patrick Fardy, 
native of Ireland. 

George D. Yanness, native of New York ; instead of George 
D. Vanness, native of New Jersey. 

Samuel Wood, native of Russia; instead of Samuel Wood, 
native of Maine. 

John Butter, native of Boston, Massachusetts ; instead of John 
Butter, native of Edyartown, Massachusetts. 

Jacob K. Woodbury, native of Boston, MasssacJiusetts ; instead 
of Jacob K. Woodbury, native of Beverly, Massachusetts. 

George W. Martin, native of Maine ; instead of George W. 
Martin, native of Lynn, Massachusetts. 

John E. Woodbury, age 35 ; instead of John E. Woodbury, 
age 21. 

Paragraph 166 of the Regulations for the Government of the 
Navy requires a muster of the officers and crew, at which the 
executive officer, surgeon, and paymaster shall be present, 
whenever a ship shall be put into commission, "for the^turpose 
of verifying the descriptive lists, of ascertaining that the name 
of every man is correctly registered, and that every one has the 
exact uniform dress prescribed by regulations," at which muster, 
any discrepancy in the descriptive lists, or even in the transfer 
roll, shall then be corrected. But if the objects of this regula- 
tion are not very generally ignored, except as regards the 
inspection of uniform, the examination of the descriptive lists 



12 MEDICAL AND SURGICAL ESSAYS. 

is certainly never conducted in the critical spirit intended, nor 
is such r>ossible as a general muster, and even when errors are 
discovered paymasters very strenously object to the alteration 
of the entries in their books. The three officers indicated should 
sit as a board, and deliberately and carefully examine every 
individual of the crew singly, with regard to the spelling of his 
name, his age, nativity, and correspondence with the other items 
of the descriptive lists. 

The points to be particularly noted by the examining medical 
officer at the rendezvous, are: 

1. Name in full — middle, if any, and in his native language. 

2. Nativity — specifying town or other locality. 

3. Age — in years and months at time of shipment. 

4. Height in feet and fractious of inches. 

o. Circumference of thorax, at the level of the nipples, after 
full inspiration and prolonged expiration. 

0. General development and figure — slender, robust, corpulent, 
muscular, stooping. 

7. Intelligence — good, bright, ordinary, obtuse, &c. 

8. Face — oval, square, high-cheeked, freckled, pock-marked, 
smooth, bearded, &c. 

9. Forehead — high, low, receding, prominent, &c. 

10. Complexion — pale, fair, florid, dusky, tawny, swarthy, 
quadroon, mulatto, negro, &c. 

11. Hair — light or dark, chestnut, brown, auburn, sandy, red, 
flaxen, gray, black, thin, bald, straight, curly, wool, &c. 

12. Nose — large, small, aquiline, pug, flat, sharp, bent, &c. 

13. Mouth — small, large, thick or thin-lipped, &c. 

14. Teeth — perfect, irregular, deficiencies, &c. 

13. Distinguishing marls— smoothness or hirsuteness of sur- 
face, prominence of pomum adami, peculiarities of ensiiorin 
cartilage, hollowness of sternum, prominence, rotundity, or 
flatness of abdomen, unusual size or smallness of penis, scro- 
tum or testes, hollowness or prominence of anal region, bow- 
legs, knock-knees, splay feet, largeness of hands, feet or joints, 
besides every abnormal feature not inconsistent with perfect 
bodily vigor, such asjnrevi materni, discolorations, cicatrices, 
outgrowths, varicose veins, deficiencies, &c. 

The certificate of the applicant that he is "not subject to 
fits," &c, (Form Q,) which precedes the physical examination, 
is usually signed without^hesitancy and without regard to fact. 
Cases of epilepsy, stricture of the urethra, lnemorrhois, chronic 



MEDICAL AND SUKGICAL ESSAYS. 13 

rheumatism, old injuries, congenital and inherited affections, 
present themselves on the sick list of every vessel in commis- 
sion, encumber sick-bays, and materially interfere with the 
health and the comfort both of the well and of those who have 
become sick in the performance of duty. If the certificate of 
exemption from these complaints were required to be in the 
form of an oath, and its fraudulent signer were subjected to 
court-martial and punishment as a perjurer, these cases would 
soon become infrequent. 

In this connection I desire to propose a system of physical 
examinations, which may assist the younger medical officers 
who have had little or no experience in such duty. 

1. The examiner must satisfy himself of the sobriety and 
cleanliness of the applicant. It is proper to require a bath 
before examination, for the better exposure of syphilides, &c. ; 
and the least evidence of the narcotic effect of alcohol upon 
the eye, face, or heart, should decide the medical officer to 
decline proceeding any further at that time. 

2. The applicant having then made oath or affirmation of his 
freedom from any disability of which he is himself cognizant, 
let him stand erect before the examiner in a broad light, and 
perfectly nude, with chin elevated, heels together, and arms 
hanging extended, and let him slowly turn so as to present his 
front, rear, and sides in succession. This inspection will satisfy 
the examiner of the unfitness of the applicant should he have 
an attenuated or crooked form, cutaneous or other external 
disease, excessive development of fat, softness of muscular 
tissue, oedema, deformities, tumors, extensive cicatrices, nodes, 
varicosities, &c. 

3. The general appearance being satisfactory, the next point 
to be determined is the existence of venereal disease. I par- 
ticularly advise a careful inspection of the internal epitroch- 
lear spaces and posterior cervical region for indurated lym- 
phatic glandulse, as positively indicative of the existence of a 
syphilitic taint. The penis should be scrutinized in its entire 
length, the prepuce retracted, the glaus and orifice carefully in- 
spected, the urethra compressed, and the man required to cough 
to eject purulent matter. Most men affected with gonorrhoea 
or gleet, wash out the urethra by urinating immediately before 
entering the examining-room; so that when there is any reason 
to suspect this disease, it is well to look at the urethra again 
after all the other examination has been completed. The flexion 



14 MEDICAL AT\'D SURGICAL ESSAYS. 

of the glands upon the dorsum, and firm pressure near the bulb, 
generally occasion so much pain that the man winces and ex- 
poses himself, even when there is no discharge discernible. 
The scrotum should be carefully examined for varicocele, cirso- 
cele, orchitis, and the other diseases of these parts. Any per- 
manent abnormal condition, singularity of development, reten- 
tion of testis, induration of globus minor, and vas deferens, &c, 
should be noted on the descriptive list. Notwithstanding the 
large proportion of sailors affected with stricture of the urethra, 
it is scarcely possible to guard against their shipment except 
by requiring them to certify on oath to its non-existence, and 
by punishing them by sentence of court-martial on the subse- 
quent exposure of the deception practiced. Few Americans 
could be persuaded, like the French, to submit to the introduc- 
tion of a bougie ; and it would be almost as repugnant to 
require them to urinate in the presence of the examiner. 

•4. Direct the applicant to stoop over, touching his toes with 
his fingers, the knees stiffened, and in a straight line Avith the 
legs, the feet apart, and the nates exposed to a strong light. 
Separate the latter widely, and inspect carefully to discover 
luemorrhois, prolapsus, fistuhe of the anus and perinaeum, &c. 
The latter diseases very often escape observation, and when 
overlooked, constitute the grounds for so many applications for 
survey. I remember one man who had been operated upon for 
fistula ani at two hospitals, reported himself on my sick-list on 
board the Treble, was again the subject of operation, transferred 
to a third hospital, and discharged from the service. A few 
months later I again encountered him an inmate of that same 
hospital. 

5. While the man is still stooping, make forcible pressure on 
each of the spinous processes of the vertebrae, to discover 
spinal affections, and over the renal regions for evidences of 
tenderness. 

G. Cause him to rise and face the examiner; present both 
the dorsal and palrnar surfaces of both hands ; flex and extend 
every finger; grasp with the thumb and forefinger and with the 
whole hand; flex and extend the wrists and fore-arms; pronate 
and supinate the hand ; perform all the motions of the shoulder- 
joints, especially violent circumduction ; extend the arms at 
right angles from the body, and from that position touch the 
shoulders with the fingers ; elevate the hands above the head, 
palm to palm, then back to back, and, while standing thus, ex- 



MEDICAL AND SURGICAL ESSAYS. 15 

amine the axilla? and groins for enlarged lymphatics, and the 
latter regions closely for fistulous openings, hernia?, and relaxa- 
tion of the inguinal parietes predisposing to ruptures, compel- 
ling the recruit to bend forward, cough and strain repeatedly 
and violently. Inspect the abdomen for umbilical hernia, and 
for enlargement of the liver and spleen. Xext cause him to 
evert and invert the feet ; to stand on the heels and then on tip- 
toe, coming down on the heel quickly and heavily, and lifting 
the toes from the floor ; to bend each thigh alternately high up 
on the abdomen, and while standing on one leg to hop with each 
foot ; to squat low down by bending both knees and thighs, 
and to rise quickly from this position ; to perform all the mo- 
tions of the hip-joint ; to walk backward and forward slowly 
and at double-quick, and thus to exercise every articulation of 
the body in all its movements. 

7. Examine the thorax by percussion and auscultation, espe- 
cially in the infraclavicular and cardiac regions, at the same 
time observing the radial pulse ; cross the arms upon the chest, 
placing each hand upon the opposite shoulder, and inclining 
the body forward, examine the posterior regions of the thorax. 
Observe the movements of the chest during prolonged inspira- 
tion and expiration, recording its extreme dimensions by mea- 
surement with a tape in a horizontal direction immediately be- 
low the nipples. In this connection, the indications of the ex- 
piratory and inspiratory power afforded by the hemadynamom- 
eter would be valuable. Observe the effects of violent exercise 
upon the pulse and respiration. 

8. Examine the scalp for cicatrices, depressions, tinea, &c. ; 
direct the head to be bent forward and backward and to be 
rotated upon the neck ; observe the motions of the lower jaw. 
Examine the ears for polypi, disease of the membrana tympani, 
&c. Test the hearing by asking questions in an undertone, at 
a distance, each ear being alternately closed by an assistant. 
Examine the eyelids and eyes, closing and opening them to 
observe the motions of the iris. Test the eye-sight by requir- 
ing the applicant to read test-types, or distinguish articles of 
various sizes and colors at proper distances, using each eye 
alternately. Xote the absence of cilia, corneal opacities, red- 
ness of tarsal edges, obstruction of the puucta, &c. Throw 
back the head and inspect the nostrils for polypi, ozsena, &c. 
Examine the teeth, noting great defects. Absence of all the 
teeth of one jaw, or of all the molars, is sufficient reason for 



1G MEDICAL AND SURGICAL ESSAYS. 

rejection, since imperfect mastication, especially when the man 
is restricted to the regular sea- ration, is very apt to cause dys- 
pepsia and its consequences. Note if the cutting edges of the 
central incisors are excavated internally, believed, on good 
grounds, to be indicative of congenital syphilis. Depress the 
tongue and examine the fauces for hypertrophied tonsils, syph- 
ilitic ulceration, mucous patches, &c. 

9. Ascertain whether he has been vaccinated, or presents 
satisfactory evidence of having had variola. 

10. Discover by adroit questioning with what diseases he has 
been affected, and of what his parents or near relatives have 
died. This part of the examination is important, as it enables 
the medical officer to discover the fatuity or imbecility of the 
applicant. Many officers probably remember a man named 
Benjamin Traman, who has several times appeared in the ser- 
vice as an ordinary seaman. lie was utterly inefficient on board 
ship, and was twice sent to naval hospitals. Any careful ob- 
server ought to have been satisfied, after a few minutes' con- 
versation, that this man was of very feeble intellect. Unprin- 
cipled persons sometimes attempt to impose weak-minded boys 
upon the service to rid themselves of their care. I was witness 
to two such attempts, in the year 1SG0, at the naval rendezvous 
at New York, by ministers of religion, one of them an officer of 
a charitable orphan asylum. 

At the risk of the accusation of imposing unnecessary labor 
upon the examiner, and of making the inspection needlessly 
tedious to the subject, I urgently advise the establishment of 
dynamometric tests for ascertaining the absolute and relative 
strength of the individuals presenting themselves for shipment, 
as furnishing important data for determining their ability to 
perform the labor and endure the fatigues of a nautical career. 
I do not recommend this, however, for the object proposed by 
the French hygienists, the stationing of the crew according to 
indications of the d3-uamometer. Thus, Keraudren, writing on 
this subject, states, "other things being equal, we consider 
these sailors who are endowed with great manual strength as the 
most proper to be stationed in the tops ; we know what a pre- 
hensile power topmen require to gather up or reef a sail, which 
is blown about or distended by the wind. These men, on the 
contrary, who possess a considerable renal (lumbar) strength 
should be assigned to the battery, and particularly to the work- 
ing of guns of heavy caliber." No complex apparatus will be 



MEDICAL AND SURGICAL ESSAYS. 17 

required for the purpose I suggest. It is desirable to ascer- 
tain aud record the hoisting, hauling, aud lifting power of the 
individual. The number of pounds which he can elevate a cer- 
tain distance, or the height to which he can elevate a certain 
weight by pulling steadily on a rope led through a block over- 
head, will give the first; by hauling on a rope led horizontally 
through a block fastened at the level of the waist, the second 
will be ascertained ; while the third may, of course, be obtained 
by attaching as mauy weights to a bar or ring as can be lifted 
the same distance in the ordinary way. These very simple con- 
trivances may be extemporized on board any vessel, and may 
readily be introduced into the examining- room of the rendez- 
vous. The numbers obtained are not to be entered on the de- 
scriptive list, but should be recorded on the medical officer's 
register for statistical purposes, along with those indicated by 
the hemadynamometer, should its use also be authorized. 

THE RECEIVING-SHIP. 

The receiving-ship is the nursery of the man-of-war's man. 
First impressions are enduring, and the sailor will be perma- 
nently influenced by the examples he sees around him on 
entering the service. The receiving-ship should be a disciplined 
man-of-war. The recruit, with his civilian clothes, should cast 
off his civilian habits, and witness, at the very outset, the 
spectacle of order, cleanliness, and discipline, to which he will 
be subjected during his whole naval career. 

When the recruit leaves the rendezvous, he is furnished with 
a descriptive list and a due-bill for the authorized advance, but 
instead of at once repairing on board, he returns to his board- 
ing-house, indulges in a last debauch, and is finally carried off 
to the receiving-ship by his landlord. He is required to pre- 
sent himself clean, sober, and, until recently, outfitted. He is 
now allowed to obtain his clothing from the paymaster of the 
receiving-ship, but it is a matter of regret that this is not made 
compulsory. The furnishing Of the outfit constitutes a large 
part of the business of boarding-house keepers, aud of a class 
of persons who have shops attached to or adjoining the rendez- 
vous, and who seize upon such of the recruits, usually boys, 
landsmen, and merchant-men, as they can persuade to patron- 
ize them. 

The recruiting office ought undoubtedly to be either on board 
the receiving-ship, or within the precincts of the navy-yard, 
2 M 



18 MEDICAL, AND SURGICAL ESSAYS. 

and the agency of the landlord entirely ignored by the Govern- 
ment. The vast majority of men now received in the naval 
service are picked up by the "landsbark" as soon as they are 
paid off from a cruise, supplied with rum, board, and money 
for prostitutes as long as he sees fit, and then carried by him 
to the rendezvous, where he receives their descriptive lists aud 
the due-bills for their two or three mouths' advance, aud whence 
he takes them back to his tavern, indidges them iu a farewell 
spree, outfits them with worthless clothing, and then transfers 
them to the receiving-ship. If any of them have had honor- 
able discharges, he increases his bill proportionally, and like- 
wise receives the three months' extra pay to which that dis- 
charge entitles them. The descriptive list and due-bill ought 
in every instance to be delivered only to the recruit himself, 
who should be informed that he must obtain his outfit aboard 
the receiving-ship, unless he is iu possession of clothing from 
paymaster's stores. He ought to be required to proceed at 
once to the receiving-ship, and when this is not done, the med- 
ical officer of the rendezvous should inform him that he has to 
be re-examined, and that he must wash his body, dress cleanly, 
and have his hair cut short before reporting himself on board. 
After the second examination by the surgeon of the receiving- 
ship, which is preliminary and requisite to his acceptance, and 
which is absolutely necessary, not only for detectiug recent 
venereal affections, but for discovering anything that may have 
escaped the first examiner, he should be required to bathe 
thoroughly, using warm water and soap, under the supervision 
of the master-at-arms, in a part of the vessel especially assigned 
for that purpose, and be provided with the outfit of clothing 
indicated elsewhere. His former clothing should be returned 
to his family or disposed of for his benefit. From this time he 
should be regarded as the child of the Government, and should 
be cared for by the officers who represent that Government. 
He should be taught the necessity of obedience, the certainty 
of punishment for misdoing, and of reward for meritorious 
conduct, and he should be assured that the arm of authority 
by which he is chastised is also powerful to defend him from 
imposition and injustice. There is a class of persons who have 
filled certain petty officers' positions on board receiving-ships 
for years, and who, like the sutlers at the various marine bar- 
racks, take advantage of their stations to extort money from 
new men on various pretenses, or make loans to them at exor- 



MEDICAL AND SURGICAL ESSAYS. 19 

bitaut rates of interest. Some of these persons have acquired 
large fortunes by their nefarious trade, which they adroitly con- 
ceal from the officers of the vessel, who are continually chang- 
ing and do not become familiar with or are indifferent to their 
extortions. Every transaction of this kind should be strictly 
prohibited by law, and every infraction of the law severely 
punished, a monthly allowance of pay, conditional upon good 
behavior, removing the excuse for obtaining money in this way. 
This is not ground foreign to hygiene. The moral health of a 
crew is as necessary to discipline and efficiency as the normal 
condition of their bodies. The superiority of the modern over 
the old-time sailor, as an intelligent, thinking man, is evident 
to the unprejudiced, and the late war demonstrated that he 
was no less zealous, brave, and competent than his ruder pre- 
decessors, who made a naval reputation for their country. It 
is the province of hygiene to correct all errors and abuses what- 
soever which enfeeble the body, obtund the mind, or degrade 
the moral nature of the sailor. The purpose of its suggestions 
is to diminish sick lists, empty brigs, and banish from the 
berth-deck the filth, obscenity, and profanity, of the existence 
( of which only those are ignorant who never visit it except 
when it is prepared for inspection. 

The sanitary -regulations applicable to receiving-ships are the 
.same as those I shall recommend to be adopted on board cruis- 
ing vessels. They do not, therefore, need any special discus- 
sion in this place. 

Before being drafted to a sea going vessel, every man should 
be inspected by the executive officer as to the completeness of 
his outfit of clothing, and by the medical officer as to his health 
and cleanliness. The executive and medical officers of the sea- 
going vessel should also carefully inspect them as they come on 
board. Under the present system, men are sent away usually 
scantily clothed, sometimes in ill-health, and generally unclean 
in their bodies. I have known vessels to receive their crews 
in the winter season, a majority of the men being without mat- 
tresses, blankets, under-clothing, stockings, jackets, or over- 
coats, and many of them infested with vermin, with which they 
were compelled to suffer several weeks, the intensely cold 
weather rendering.it impossible to cleanse their bodies. It is 
not uncommon to clear off the sick list of the receiving-ship 
by sending its most troublesome habitue's away with a draft, 
and when these men have to make a passage in a dispatch- 



20 MEDICAL AND SURGICAL, ESSAYS. 

boat or tug, to some distant navy-yard, they are frequently 
exposed for several days to the rigors of our coast, always in- 
sufficiently clad, and forced to sleep about the decks, without 
bedding, wherever they can find a place. Such men invariably 
report for treatment as soon as they get on board the vessel to 
which they are ordered. Many others, who were well when 
they started, contract severe acute diseases, which disable them 
when their services are most required, and often entail perma- 
nent organic changes, for which they have to be invalided 
sooner or later during the cruise. The medical journal has usu- 
ally to be opened as soon as the ensign is hoisted and the vessel 
put in commission, and the apothecary is at work compounding 
prescriptions before the cook has lighted his fire at the galley. 
The transfer of a case of parotitis from the sick-bay of the 
receiving-ship to that of the Tennessee, a transfer effected with- 
out the consent of the medical officers, resulted in the illness 
from that disease of more than seventy of the crew of the lat- 
ter vessel. Every man-of-war should begin her cruise under 
the most favorable circumstances possible, and hygiene exacts 
nothing so important as that every man shall be in good health 
and provided with all the clothing he may need. The necessity. 
for the vessel remaining a few days at the navy-yard after going 
into commission is apparent, that omissions may be supplied 
and provision made for every possible contingency, but it is no 
less important for the Government to provide a proper trans- 
port, with adequate berthing accommodations, for drafts of 
men sent from one naval station to another. 

NAVY-YAKDS. 

There is a medical officer attached to every navy-yard, whose 
special and almost only recognized duty is to attend the sick 
among the officers and marine guard and to examine applica- 
tions for enlistment in the Marine Corps. His more important 
functions should pertain to the sanitary considerations involved 
in the construction and proper preservation of the home of the 
sailor— questions similar to those within the province of civil 
health officers. If it be important to require architects to con- 
sider hygienic principles in the construction of dwelling-houses, 
it is of no less consequence to insist that ship-builders shall 
have regard to the healthfulness and comfort of the structures 
in which so many thousand men have to pass so large a portion 
of their lives. In claiming for the medical corps this pro- 
fessional interest in the building of vessels, and the care of 



MEDICAL AND SURGICAL ESSAYS. 21 

those in ordinary, no interference is sought with the customary 
routine of dockyard duty. The recommendations of the med- 
ical officer are of general applicability, and would be better 
embodied in stringent regulations of the Department than left 
to the suggestion of individual officers. The medical officer 
•of the navy-yard is, doubtless, the proper person to supervise 
the observance of these regulations, and call attention to their 
neglect by subordinates. 

The objects it is urged upon the Department to enforce by 
regulation are — 

1st. To preserve vessels in ordinary and those building as dry 
as possible. 

2d. To keep them perfectly clean. 

3d. To provide the most perfect means for their ventilation ; 
and 

1th. To provide the most perfect means for the admission of 
light into their interior. 

Dampness, dirt, foul air, and darkness are the direst enemies 
with which the sailor has to battle when afloat. They can never 
be wholly routed and conquered, but they may be subdued and 
rendered comparatively harmless. Leagued together, they 
slaughter more than all the adversary's powder and shot. The 
most accomplished ordnance officer has no more subtle and 
powerful ally, in the work of bringing death to his country's 
foes, than the poor hygiene of his opponents. Sir Gilbert Blane 
attributed the failure of the British arms during our war of 
independence to the deficiency of numbers, and want of strength 
and energy of the men from excessive sickness and mortality, 
and declared that if the same death-rate in their navy had con- 
tinued during the French revolutionary war seamen would no 
longer have been procurable, and their famous victories have 
never been achieved ; so that, says Professor Guy, " it was not 
the seamanship and fighting qualities of our sailors alone that 
•carried us triumphantly through that terrible contest, but a 
reduced mortality, due to the sanitary discoveries and reforms, 
which first recruited our population by saving lives in infancy 
and childhood, and then cut off from our forces by sea and 
land, the destructive supplies of jail-fever, scurvy, dysentery, 
and small-pox." Therefore, while inventive talent is being 
strained to meet the exigencies of an exceptional state of war, 
let something be done to stay the murderers who are dealing 
out death as well in times of peace as in those of conflict. 



22 MEDICAL AND SURGICAL ESSAYS. 

It is not expected that ships can ever be made as comfortable 
and healthful as homes on land. The creatures that swim the 
sea and those that roam over the earth eacli have their habits. 
The carpeted and mirrored steamship, like the painted harridan, 
is pretty only in spots. Her foul and unclean parts are only 
masked by the local splendor. The attempt at reform need not, 
however, be stopped because absolute perfection is impossible. 
Humanity demands that all should be done that may. The 
floating hells of the past century, and the rude, strange race 
who lived and died upon their ocean borne, who spoke a lan- 
guage unintelligible to shore folk, and were ignorant of the 
customs of the laud world, havebecome historical. Sailors are 
men, and ships the babitatious of men, but there is still tilth 
and depravity and sickness where there might be cleanliness 
and decency and health. The medical corps is laboring to this 
end ; not to overturn for the sake- of overturning, as has been 
unkindly and maliciously insinuated. 

The first great fact which should be impressed on all naval 
constructors, sailing officers, and dock-yard officials, is the 
necessity of keeping a vessel as dry as possible, not only Avheu 
in commission and in ordinary, but even when on the stocks. 
The wood of which a vessel is composed is a dead organic sub- 
stance, subject to molecular decay, which is accelerated by heat 
and moisture. The temperature is to a certain extent beyond 
our Control, but it is not altogether out of our power to main- 
tain a certain degree of dryness, which will not only retard this 
decomposition, but diminish one of the causes of that humidity 
on board ships which I shall presently show to be so prejudicial 
to the health of the crew. All vessels should be built under 
cover, in dry seasons of the year, of old and seasoned timber, 
and the operations of building should be conducted slowly, so 
that a circulation of air may take place between all parts of the 
frame. When timber has been allowed to soak in salt water 
for purposes of preservation, it should be thoroughly dried 
before being used in the construction' of vessels. Green wood, 
from the amount of contained sap and the softness of its tissues, 
is more readily decomposed than old hard timber in which the 
wood cells are compact, and vessels constructed of it are 
notoriously unhealthy. Fonssagrives, whose excellent work 
on naval hygiene is the most complete that has ever been pub- 
lished, narrates two instances in point : u We are indebted to 
M. Delalnn, capitaine de vaisseau, for the two following facts 



MEDICAL AND SURGICAL ESSAYS. 23 

demonstrating the influence of the mode of. construction of ves- 
sels upon their salubrity. At Navarino the crews of our vessels 
wore properly subsisted and were spared by the scurvy. The 
vessel of Admiral de Rigny alone, although it had fresh meat 
twice oftener than the others, was decimated by this affection. 
There were about eighty men constantly on the' sick-list. The 
fact was explained by the humidity of the wood which was used 
in this vessel and by the rapidity of its construction. The impro- 
vised squadron of Antwerp (1S12-'13) had been built of wood 
felled while in sap. At the end of eight years all these vessels 
were out of service, and there was not one of them that could 
be repaired. The ship L'Hector, among others, was so rotten 
that she could not even be used as a hulk. She was constantly 
full of scorbutic cases." The histories of our own "ninety-day 
gun-boats" and " double-enders" illustrate the same fact. 

Vessels in ordinary should - be immediately housed over. 
When fitting out for sea it should be the special duty of the 
watchman or ship-keeper to carefully close all hatches and ports 
in wet weather and open them in dry. It is not unusual when a 
vessel is in the hands of the navy-yard employes to find her 
lower decks flooded with water or piled up with snow, even 
when her crew is hourly expected on board. Large painted 
awnings or tarpaulins should be provided and so arranged as 
to be quickly spread on the occurrence of rain or snow. 

No vessel can be made absolutely impervious to water. It 
finds entrance by a thousand channels, by opening seams, by. 
worm-holes, by leakage from tanks and casks, by the condensa- 
tion of the aqueous vapor in the atmosphere. Great care should, 
therefore, be taken in ship building that it be allowed to run 
down freely into the timbers and find access, without obstruc- 
tion forward or aft, to the pump-well, whence it can be daily 
removed. Medical Inspector Joseph Wilson, in his work on 
naval hygiene, calls attention to a very common defect in 
pumps, which are too short to reach to the bottom of the well 
and thus discharge all the accumulated water. I translate the 
following instance quoted by Fonssagrives from a thesis on 
dysentery by M. Collas, a surgeon in the French navy, illus- 
trating the danger that may result from any obstruction to the 
discharge of this bilge-water : " The corvette La Triomphasite 
was anchored at Nouka Hyva, at a point where there were no 
marshes. There was not a single case of dysentery on shore. 
Soon afterward this disease commenced to rage on board. The 



21 MEDICAL AND SURGICAL ESSAYS. 

agitation of the vessel, first by a gale of wind and then by 
getting aground, soon caused new cases to appear. The bold 
was examined, and under the store-room a pool of stagnant 
water was found which could not run into the pump-well, the 
vessel being down by the head from the anchors on the bow. 
The place was carefully cleaned and the epidemic disappeared." 
It would be supposed to be impossible to make complaint of 
the uncleanliness of newly-built vessels, but it is a fact that 
there are few which do not carry with them from tbe stocks as 
great a source of disease as the foulness accumulated by a 
whole ship's company during a cruise. There is a general 
neglect, inexcusable and criminal because it does not involve 
much trouble, to remove the chips and other remains of building 
materials, which collect on the floor of the vessel and are 
planked up under the ceiling, where they remain year after 
year, decomposing under the influence of confined and heated 
air and the admixture of fresh and salt water constantly in the 
timbers. The report of tbe Portsmouth Belief Association 
upon the origin of the yellow fever which prevailed at Norfolk 
aud Portsmouth, Virginia, in the year 1855, relates an instance 
of frightful extent of illness traceable to this cause ; and an illus- 
tration quite as conclusive was furnished by the United States 
ship Macedonian during her cruise on the north coast of South 
America. The fact was communicated to me by her first lieu- 
tenant. Numerous cases of fever having occurred on board 
this vessel, it was remarked by her surgeon, now Medical Direc- 
tor Grier, that the men attacked were chiefly those who slept 
in the forward part of the vessel. A local cause was suggested 
and discovered by scuttling the fore peak. As soon as an open- 
ing was made a noisome effluvium arose, and a caudle intro- 
duced into the peak was instantly extinguished. Both sides 
were scuttled, wind-sails were let down, and after the place 
was sufficiently ventilated to allow men to descend into it with 
safety was cleaned out. More than fifty bucketfuls of putres- 
cent vegetable matter and several hogsheads of foul discolored 
water were removed. From this time the disease disappeared. 
A letter in the London Times, September 18, 1861, from 
Halifax, where Her Britannic Majesty's ship Jason then was 
states that " she is a new vessel, built of green wood; her bilges 
cannot be kept sweet; the officers have tried all means to do 
so without success. This is considered the principal cause of 
her being so unhealthy. The stench is abominable, particularly 



MEDICAL AND SUUC1ICAL ESSAYS. ' 25 

in the after part of the ship and in the officers' cabin, and the 
Jason is not'the only sickly ship in which such a nuisance has 
existed." 

Naval constructors will, doubtless, admit that when plan- 
ning vessels the very last subject, if ever, in their thoughts is 
hygiene. They aim at buoyancy, speed, strength, lightness of 
draught, but never salubrity. The means of ventilating a ship 
in commission will be hereafter referred to, but the constructor 
has it in his power to make those means much more efficacious 
than they can be under the present system of internal arrange- 
ments. There should be no such thing as a solid bulkhead in 
the inhabited part of a vessel. Some of our finest ships have 
their berth-decks ruined by being divided into four or five close 
compartments by as many complete transverse bulkheads. 
Every partition, those separating private apartments as well as 
those marking the larger subdivisions of ward-room, steerage, 
warrant officers' steerage, sick-bay, &c, should be latticed or 
gratinged above and below. This can always be dnoe without 
any sacrifice of strength. The cabin and ward-room bulkheads 
and doors usually have Venetian blinds or perpendicular bars 
in their upper part, but the lower panels should also be perme- 
able to air, and all other bulkheads, whether of store-rooms, 
lockers, sail-room, shell-room, &c, should be arranged in the 
same way. Every place should be accessible to air, which 
should circulate freely forward and aft on every deck of the 
vessel. The furniture of officers' rooms is not only antiquated 
and inelegant, biit such as unnecessarily dimiuishes the cubic 
air-space of the rooms. Cumbersome and unwieldy bureaus, 
bunks, and wash-stands are taken out and restored, cruise after 
eruise, without change or improvement. Instead of the huge 
box-like wash-stand, a neat iron upright, with rings for Basin 
and pitcher, sockets for mug and soap-block, and hooks for 
towels, might be devised to occupy one-fourth the space. The 
bureau could be made of much lighter materials, and the bunk 
would be far more comfortable if constructed on the principle 
of the French swinging cradles. A neat style of clothes locker 
might be contrived of wire, which would be cleaner, more com- 
modious and more ornamental than the great wooden boxes 
and drawers that are now never opened nor closed without dif- 
ficulty. These changes would furnish space for a much larger 
amount of respirable air, and if, in addition, all the bulkheads 
were latticed; though only for a few inches at the top and hot- 



26 MEDICAL AND SURGICAL ESSAYS. 

torn, the officers' room would not be sucli an inclosure of con- 
fined and heated air, from which the occupant escapes on deck 
in the morning with nausea, dyspcea, and headache, and to 
which he returns with loathing at the dampness and foul smell 
he encounters. 

The apertures for the admission of light are necessarily few. 
These are the gun-ports, air-ports, and hatchways. Sometimes 
deck-lights of very thick glass are introduced in the ward-room 
and cabins, and might with great propriety and no risk be dis- 
tributed forward over the berth-deck. 

These improvements are all feasible iu old as in new vessels. 
^Taval constructors would undoubtedly cheerfully exercise their 
skill iu the furtherance of these hygienic objects if the matter 
were brought officially to their notice. Some of these gentle- 
men, with a laudable desire to contribute to the comfort of 
officers, have introduced the novelty of bathing tubs, and I 
am, therefore, sure they would be no less disposed to devise 
improvements conducive to tbe health of those who have to 
inhabit the floating houses they put together. 

HUMIDITY. 

The great danger the sailor encounters is water. Xot the 
mighty deep he traverses, on whose wide waste he is but an 
indistinguishable speck, and from whose depths he is only sep- 
arated by a few inches of plank. It is not the water without 
his vessel that imperils his life so much as that within it — that 
Avhich saturates his clothes and bedding, fills the air he breathes, 
and, creeping in wherever that air can enter, permeates the 
very tissue of the wood of which his ship is built. This is his 
enemy ; terrible because unseen, powerful because denied, de- 
preciated and therefore unresisted. Fewer lives are lost by 
shipwreck than by the operations of this subtle agent. Man's 
skill has mastered the fury of the ocean. He is able to oppose 
its storms and currents, and go upon its surface as he lists, but 
he makes no attempt to combat this insidious slayer. 

The daily variations in the hygrometric constitution of the 
atmosphere do not amount to more than a few grains in weight 
per cubic foot. Air is saturated at 52° F. by 1.42 per cent, of 
its volume of aqueous vapor, in weight about four and a half 
grains to the cubic foot. As the temperature rises it becomes 
able to retain a larger quantity of vapor in solution, being satu- 
rated at 77° F. by three per cent, or 9.8 grains, while at the 



MEDICAL AND SUB&ICAL ESSAYS. 27 

freezing point it holds only a fraction over' two grains, or less 
than one per cent, of its volume. Ordinarily, it seldom con- 
tains more than two or three grains, or from thirty to fifty per 
cent, of the quantity of water in the state of vapor required to 
completely saturate it. The fluctuations in humidity, which 
the rheumatic invalid appreciates so sensitively, sometimes cor- 
responds to a change of weight of less than a single grain. 
The marine atmosphere normally contains a larger amount of 
aqueous vapor than the terrestrial, and on board ship the pro- 
portion is further increased by the exhalation of fluid from the 
surface of the bodies, and very greatly by that from the lungs 
in the act of expiration of the bodies of the men confined upon 
it, twenty-five to forty ounces of water being discharged daily 
by each individual in this way. The evaporation from a wet 
deck supplies water enough to the atmosphere to raise it to its 
point of saturation, aud when this is repeated without regard 
to temperature and season, all these evils result, which are 
attributed by the scientific to the prolonged influence of moisture 
aud heat, and which have conferred upon the climate of the 
west coast of Africa its notorious uuhealthfulness ; and as far 
as my own observation has extended it has generally escaped 
attention that these two morbific influences usually act in con- 
junction. According to Tyndall the aqueous vapor of the 
atmosphere absorbs solar heat radiations with rapidity, and the 
greater the amount of vapor and the more humid the atmos- 
phere the greater will be the amount of heat absorbed, and 
consequently the smaller will be the excess of sun temperature 
over that of the shade. Hence, a ship, the atmosphere of which 
is always kept near the point of saturation by being frequently 
deluged with water, will have the temperature of its shaded 
parts raised almost to the height of those exposed to the un- 
shielded sun. In temperate climates the usual average yearly 
excess of suu over shade is twenty degrees, and in the tropics 
it is three times as much. It is evident, therefore, that the 
beneficial effect of spreading awnings is very much diminished 
and the temperature of the lower decks greatly augmented, if 
the ship is kept damp, and this is not inconsistent with the 
fact that the occasional sprinkling of a dry heated uncovered 
spar-deck momentarily reduces the temperature through evap- 
oration. 

Siuce, then, such minute differences in the amount of aqueous 
vapor in the atmosphere disturb the harmonious action of the 



28 MEDICAL AND SURGICAL ESSAYS. 

function^ of the human body, bow urgently necessary lire tbese 
measures of precaution which are insisted on by medical men ! 
Tbere is but one opinion on tins subject among naval surgeons 
all over the world. " Humidity," says Pringle, " is one of the 
most frequent causes of the derangement of health ;" and Fons- 
sagrives, the greatest authority on naval hygiene, uses this 
language : " The practice of medicine on board ship confirms 
the truth of this assertion : Whenever a vessel may be said to 
be very damp, it may be said to be an unhealthy vessel. All 
the authors who have written on the diseases of seamen, Eouppe, 
Lind, Poisonnier-Desperieres, Keraudren, Eaoul, &c, are unan- 
imous in attributing a very great importance to this etiological 
influence. The latter, after having, in his report on the cruise 
of the Cara'ibe, analyzed the causes of the production of scurvy 
on board different vessels, and discussed all other influences, 
as nourishment, sojourn in port or at sea, different stations, &c, 
finally attributed this formidable affection to the persistence of 
humidity. All are of one accord on the insalubrity of an 
atmosphere saturated with water, in which the cutaneous depu- 
ration greatly flags, and respiration is performed with difficulty." 

English testimony is quite as decisive. Captain John Mc- 
Neil Boyd, of the royal navy, candidly admits that " the objec- 
tions to wet decks are supported by the medical officers with 
such a weight of evidence that they cannot be gainsaid, and 
if the mate of a deck does not think the health of the crew a 
matter of indifference, he may so arrange the process of clean- 
ing as to prove that dry decks are not incompatible with 
health; " and in the Life of Collingwood, it is stated that "his 
flag-ship, with a crew of eight hundred men, was on one occa- 
sion more than a year and a half without going into port, and 
never had more than six on her sick-list. This result was occa- 
sioned by his system of arrangement and his attention to dry- 
ness, ventilation, &c, but above all by the contented spirit of 
the sailors, who loved their commander as their protector and 
friend, well assured that at his hands they would receive jus- 
tice and kindness, and that of their comforts he was more jeal- 
ous than his own." 

The unanimity of our own medical corps in this matter, in- 
stead of attracting that attention and respect it deserves from 
commanding and executive officers, is too often regarded as a 
simple perverse contrariety of opinion, having no other object 
than a mean and petty attempt to interfere with the routine of 



MEDIOAL AND SUUCHCAL ESSAYS. 29 

the ship ; and this ungenerous belief will probably continue un- 
til the principles of hygiene are better understood by the officers 
of the other corps. The consequences of ignorance on this 
point were remarkably and conclusively demonstrated on board 
the coast survey schooner Variua, during the autumn of 18G0, 
while anchored off the navy-yard at Brooklyn. The officers of 
this little vessel, desirous of emulating the customs of their 
linger men-of-war neighbors, scrubbed their decks every day 
without regard to weather. Numbers of her crew soon became 
ill with bronchial, pulmonary, and rheumatic affections, and at 
one time nearly a third of them had been sent to the hospital. 
As soon as the fact was represented to Captain (afterwards 
Admiral) Foote, then executive officer of the yard, he ordered 
the wetting of the decks to be discontinued, from which time 
her sick-list rapidly diminished. 

A ship must be kept dry to be healthy ; her crew must be 
healthful to be efficient. To promote this efficiency is alike 
the duty of medical officers as of commanders and lieutenants. 
But she must be kept clean, it is replied; cleanliness is like- 
wise essential to health. The daily wetting of the decks, how- 
ever, is not evidence of cleanliness, but of dirt. That is an ill- 
managed vessel which becomes so quickly foul. A well-ar- 
ranged ship and well-conducted crew do not accumulate dirt. 
When the weather or sea necessitates the eating of meals be- 
low, not a crumb should be spilled from a mess-cloth. The 
cooks at the galley should be required to remove grease as they 
let it fall. Tarpaulins should be spilled whenever the hold is 
broken out. The cleaning of mess things, blacking of boots, 
brushing of clothes, and every other operation that can occa- 
sion dirt, should be done in the open air. . The unclean berth- 
deck is so only because of the inattention or incapacity of the 
mate or other officer whose duty it is to take care of it. 

Berth-decks and covered gun-decks do not require to be wet- 
ted oftener than once, or at most twice, a month. They should 
then be cleaned thoroughly and not upon any stated day, but 
when the weather is such as will justify it. A dry, clear, sunny 
day, after a prevalence of fine weather, is the most proper for 
the purpose. It should always be selected and indicated by the 
commander himself, who should solicit and be guided by the 
advice of the medical officer. On these days all other exercises 
should be suspended. Every man, except the cooks and such 
others as are engaged in the work, should be sent on deck with 



30 MEOICAL AND SURGICAL ESSAYS. 

bis bag and ditty-box, and should be compelled to remain there 
until the deck is thoroughly dried. Hot water should be sup- 
plied for the purpose from the galley, and the greatest care 
should be taken not to use it in such quantities as to overflow 
the coamings of the hatches into the hold. After scraping and 
scrubbing as much as is necessary, the greatest expedition should 
be made in removing the unclean water by swabs and squill- 
gees, and then drying-stoves should be lighted and kept swing- 
ing until the decks are completely dried. The hatchways should, 
all the while, have been wholly uncovered, wind-sails let down 
to the deck, ventilators worked, and, when possible, air-ports 
opened. In this way a lower deck may be properly cleaned with 
the least detriment to the health of the ship's company. 

When a prevalence of wet weather causes the decks to be- 
come damp, they should be scraped and drying-stoves should 
be frequently lighted. No other process of cleaning should ever 
be tolerated. A practice prevails on board some vessels which 
cannot be too strongly reprobated, of going over the berth-deck 
every morniug with a wet swab, for what purpose it is difficult 
to understand, except it be to maintain an appearance of hav- 
ing observed the ancient custom of daily scrubbing, the deca- 
dence of which some officers class with the abolition of the cat,, 
as among the causes of the degeneracy of the Navy. 

The flying berth-decks of small vessels should be scrubbed 
and dried in the open air, as should also the hatch-covers, 
ladders, and gratings of all other vessels which are wetted 
on any other than the day for the general cleaning of the lower 
decks. 

It is singular that while there is such difficulty in keeping 
water, which finds an entrance from natural causes, out of a ves- 
sel, there should be such a universal habit of deluging it above 
and below, and thus superadding an artificial and unnecessary 
cause of humidity. There is a general custom of wetting or 
holy-stoning the spar-deck every morning, which has been hand- 
ed down from the past century, with other observances that are 
equally inconsistent witli the intelligence of this age. It is very 
proper to do this when the crew have soiled the deck with soap- 
suds by washing clothes and scrubbing hammocks, and these 
occasions occur so frequently that there is no necessity for wet- 
ting it at other times, except after some special unclean work as 
weighing anchor, coaling, provisioning, &c. 

Small vessels are habitually wet when under way. This can 



MEDICAL AND SURGICAL ESSAYS. 31 

be partially obviated by greater care in fitting - bucklers to the 
hawse-holes, and by calking the bridle-ports. 

In wet weather the officer of the deck should always promptly 
cause the boom-cover to be hauled out at sea, and the awnings 
to be spread and housed Avhen in port, rather than cover the 
hatchways with tarpaulins. 

In this connection I have to suggest a protection against get- 
ting wet, which, to the disgrace of the educated officers of the 
present day, has not been already generally instituted — a hood 
for the head. Men are compelled to visit this place and sit ex- 
posed to no matter how heavy a rain or intense a sun. This is 
one of the most potent sources of diseases on board ship. A 
man gets out of his warm hammock at night, and returns to it 
with his clothes drenched with water. His blankets and mat- 
tress become wet, and in. vessels where beddings is aired but 
once in two or three months, they remain damp and foul all that 
time. On board small vessels without sick-bays and water-clos- 
ets for the sick, invalids often refuse to use the close-stool in 
the vicinity of their shipmates' messes, and watch an opportu- 
nity to elude the vigilance of the nurse and steal on deck. Very 
many cases of disease, mild in their incipieucy, have been aggra- 
vated by this cruel exposure. Nothing can be easier than to 
provide a properly fitted tarpaulin or canvas cover for the head, 
which would not only defend from the rain, but from the spray 
continually breaking over the bows at sea. Even if unsightly, 
though it need not be so, a sacrifice of appearance is a small 
evil that will be productive of so much good. So many com- 
forts have of late been instituted in cabins and ward-rooms, that 
it were only generous to extend a semblance of them to the 
berth-deck and forecastle, where the customs of civilized life 
may be initiated without greater risk of effeminacy in one case 
than the other. 

Another cause of humidity on board ship is provisioning, 
wooding, or coaling in bad weather. Unless absolutely neces- 
sary, these operations shoidd be conducted only on dry days. 
No wet or green wood, wet or unclean casks, or wet coal should 
ever be allowed below the spar deck. All coal and wood 
should have been kept under cover before being taken on 
board, and the latter should also have been deprived of its bark 
and baked. The hoops of all casks should also be barked, and 
the casks carefully swept prior to being sent below. It would 
be an additional safeguard to whitewash them, and this could 



32 MEDICAL AND SURGICAL ESSAYS. 

be repeated whenever the hold was broken out. In this way 
the hold and spirit-room may be kept perfectly clean and dry. 

It is a matter of controversy whether water should ever be 
purposely admitted into a vessel. It is manifestly improper 
Avhen it is made a daily habit for the theoretical purpose of 
"keeping the vessel sweet," and the only occasion when it is 
allowable is when bilge-water has formed. In this case the 
latter should be pumped out and fresh water admitted into the 
pump-well by a hose from the stop-cock in the ship's side, but 
not to exceed in amount- the depth ascertained by the first 
sounding of the well. This should then be discharged, a sec- 
ond supply of water admitted and pumped out, and this opera- 
tion should be repeated until the discharge from the pump-well 
is free from smell. Ou board some vessels a very reprehensible 
practice exists of opening the magazine cock and flooding the 
spirit-room and hold. Such vessels would always be troubled 
with bilge-water, which forms the more rapidly as these wettings 
are frequent. 

I would also urge the necessity of requiring kygronaetric 
observations by the medical officers of every vessel in commis- 
sion, with a careful particularization of the attendant circum- 
stances, so as to establish on an indisputable basis of fact the 
propositions here advanced. These observations should be the 
duty of the assistant surgeon, and not be delegated to nurses 
or apothecaries, who would perform it in the same superficial 
manner as the quartermasters, who record the temperatures 
indicated by the dry and " wet-bulb" thermometer. The points 
to be. determined are the degree of relative humidity and the 
absolute weight of aqueous vapor in a cubic foot or litre of air. 
It is desirable that every medical officer, on duty on shore or 
afloat, should be required to make a detailed quarterly sanitary 
report, embracing not only a summary of these and other me- 
teorological observations, but precise information on all the 
subjects that relate to the preservation of the health of the 
Navy, and which are certainly as important as the records of 
the failures to effect this object, as shown by the quarterly 
reports of sick and expenditure of medicines and medical stores 
necessary for their treatment. 

VENTILATION. 

It is scarcely possible on beard ship to supply every man with 
the thousand cubic feet of space for air which physiologists 



MEDICAL AND SURGICAL ESSAYS. 33 

declare to be the minimum that can be safely assigned, except 
when extraordinary provisions are in operation for its renewal. 
Probably no single-decked vessel in 4he service supplies one- 
third of that amount. The best authorities agree that a healthy 
man requires a supply of twenty cubic feet of fresh air every 
minute. Hammond states that thirty to forty are desirable, 
and Professor Oorkin places the minimum at three thousand 
cubic feet per hour. According to Martin, " the constant 
movements going on in the atmosphere prove that the amount 
of change which nature has provided for healthy existence is 
unlimited. The test of ventilation in a sick-ward is the com- 
parative freshness or parity of the air. The interesting ex- 
periments of Lariboisiere appears to prove that about four 
thousand cubic feet per hour- are required to insure this." The 
amount of air which passes through the lungs is variously esti- 
mated at from three hundred to four hundred and eighty cubic 
feet, four per cent, of which, at the ordinary rate of respiration, 
is carbon di-oxide, (carbonic acid gas;) that is, one hundred 
times as much as normally exists in the atmosphere, while the 
proportion is largely increased when the latter is moist, conse- 
quently were there no renewal of air by ventilation on board 
ship, one day would suffice to make its atmosphere irrespirable, 
since, according to Lankester, over six parts in ten thousand in 
a breathing atmosphere are adverse to comfort and obnoxious 
to health. The rapidity with which air is deteriorated by res- 
piration may be understood by imagining a room seven feet in 
size in each of its dimensions, and having nearly the cubic 
capacity of three hundred and fifty feet, which, containing 
normally about one gallon of carbon dioxide, will, at the end of 
two hours, all apertures being closed, have this amount raised 
to ninety-two and a half gallons by the respiration of a single 
adult man, showing that every particle of that air had passed 
through his lungs. This, however, is not the only noxious ele- 
ment acquired by air in apartments which are defectively ven- 
tilated. Every act of expiration discharges a large amount of 
aqueous vapor, raising its quantity, according to Dr. Craig, of 
the United States Army, from one to seventeen grains in a 
cubic foot, elevates the general temperature of the air, and 
thus increases its absorbent power for vapors ; and further, 
adds a variable amount of organic matters, the presence of 
which is distinctly enough indicated, even to the unprofessional 
observer who leans over the fore or main hatch towards the end 
3 M 



34 MEDICAL AND SURGICAL ESSAYS. 

of the first watch, by the heavy mawkish odor, which appeals 
to the sense of taste as well as to that of smell. According 
to Gavarret, air thus vitiated is unfit for respiration, and may 
lead to serious accidents, not on account of the carbon dioxide 
(carbonic acid gas) it contains, but from the mere presence 
of the putrid exhalations of the body, since organic matter in 
stagnant air, as that of berth-decks, putrifies as rapidly as that 
in stagnant water. Fonssagrives believes " that air may yet 
supply the chemical needs of respiration in a place crowded 
with men, when from the organic miasms which impregnate it 
it has already become a deleterious agent," and thus quotes 
Piorry : " That which is the most dangerous in the vitiated 
air of confined habitations we do not know ; chemistry does 
not inform us of it, but our senses, more delicate than chem- 
istry, demonstrate to us, in an evident manner, the presence of 
deleterious putrid matters in the air, in which man has long 
resided." Nor is respiration the only human process which 
empoisons the air. The whole cutaneous surface imperceptibly, 
but ceaselessly, contributes a determinate amount of aqueous 
vapor, carbon dioxide, and organic emanations. Furthermore, 
to produce these nocuous elements, which are thus formed into 
the atmosphere, each adult on board ship, according to Dumas, 
completely disoxygenates twenty gallons of air every hour, re- 
quiring the hourly addition of more than a hundred gallons to 
simply restore its equilibrium, disturbed by this cause alone, 
without taking into account that necessary to wash away or 
dilute the morbific vapors aud gases which have been added. 
Finally, the decomposition of provisions and ship's stores, 
especially coal, and that resulting from the admixture in the 
hold of fresh and salt water with the leakage of brine, molasses, 
vinegar, &c, all operate to deteriorate the atmosphere of the 
ship, not merely by the addition of the gaseous products of this 
decomposition, but, as in the case of the crew, by the direct 
removal of the oxygen, on which the fitness for respiration of 
the atmosphere depends. The problem of A^entilation, there- 
fore, is one of the most interesting and important that can 
occupy the naval hygienist. 

The greater number of our national vessels are overcrowded 
with men. Few can berth their whole complement. With 
hammock -hooks only fourteen inches apart, less than the breadth 
of a man's shoulders, with numbers swinging under the top- 
gallant-forecastle, many of our siugle-decked vessels, when both 



MEDICAL AND SURGICAL ESSAYS. 35 

watches are below, as in port, still have a dozen or more men 
who are compelled to billet themselves on deck, behind mess- 
chests, or wherever else they can stow themselves away. Fre- 
quently vessels are sent home from distant stations cumbered 
with men whose terms of service have expired, with prisoners, 
and with manifest impropriety the accumulated chronic invalids 
of the squadron. The ship fever of emigrant packets, and the 
typhus, not uncommon on board men-of-war twenty years ago, 
and notably virulent among the transports employed during 
the Crimean war, were due to over-crowding. Fonssagrives 
narrates the case, among others, of the corvette La Fortune, 
which having been employed in transporting Turkish troops, 
had two-thirds of her crew prostrated by this disease, of whom 
half were lost, and was obliged to land the rest at Messina. 
Even when the ill-effects of over-crowding are not so disastrous 
and manifest, they are not compensated by any advantage 
whatsoever. The effective number of the crew is reduced by a 
sick list of from fifteen to twenty-five a day, and the invalids, 
who require to be returned to the United States, ultimately 
bring down the complement of men to the capacity of the ves- 
sel. All this additional expense, as well as the discomfort 
which a large sick list necessarily occasions to the well, might 
be obviated by a reduction of the ship's company at the outset. 

Very little attention is paid to the subject of ventilation by 
officers of the Sfavy. I have heard them express incredulity 
when told there was danger from battening down hatches two 
or three days continuously, and I have seen a boy confined for 
some trifling offense six hours at a time for several successive 
days in a narrow " sweat-box,'' with only a few perforations at 
the top of the door, and none at the bottom or sides, and where, 
after sinking from fatigue below the level of the holes, he had 
to breathe an atmosphere as fraught with danger to his life as 
that of the most dreaded plague-ridden spot on earth. 

The neglect to provide proper means of ventilation has been 
often attended with rapidly fatal consequences. The case of 
the Black Hole of Calcutta, where one hundred and twenty- 
three persons out of one hundred and forty-six died after one 
night's confinement in a room eighteen feet square, provided 
with only two small windows, is familiar to every reader. Of 
three hundred Austrian prisoners confined in one room after 
the battle of Austerlitz, two hundred and sixty died ; and Car- 
penter narrates an equally horrible catastrophe which occurred 



36 MEDICAL AND SURGICAL ESSAYS. 

afloat : " On the night of the 1st of December, 1848, the deck 
passengers on board the Irish steamer Londonderry were or- 
dered below by the captain on account of the stormy character 
of the weather, and although they were crowded into a cabin 
far too small for their accommodation, the hatches were closed 
down upon them and the consequence was that out of one hun- 
dred and fifty individuals, no fewer than seventy were suffocated 
before the morning." Instances of less severity are of common 
occurrence on board men-of-war. On one occasion, nine or ten 
prisoners were confined in the main hold of a single-deck sloop- 
of-war and half of the hatch closed over them. At the end of 
four hours one of the men was taken out asphyxiated, and resus- 
citated with difficulty. The occupants of " sweat-boxes " have- 
often been found almost lifeless or have fallen. out insensible as 
the doors were opened. Dr. Billings, of the United States Army, 
in his report on barracks and hospitals, published in Circular 
No. 4, from the Surgeon General's Office, refers to instances of 
exhaustion and insensibility from confinement in " sweat-boxes," 
as experimental evidence in determining the minimum amount 
of air on which life can be supported. In the same able report, 
he fixes the proper allowance of fresh air for soldiers in barracks 
at two thousand cubic feet per hour for each man. It is useless 
to expect to violate with impunity the immutable laws of our 
existence, and therefore, so long as the circumstances of our 
nature require the inspiration of oxygen into the lungs and the 
ingestion of food in the stomach, it will be just as impossible to 
compel sailors to do without the one, and be healthy, as to ab- 
stain from the other and live, Statistical inquiries on mortality 
prove beyond a doubt that of all the causes of death which 
usually are in action, impurity of the air is the most important. 
Gay states, in his recently published lectures on public health, 
as the results of a laborious inquiry into the health of letter- 
press printers, and of others following in-door occupations,- 
" that out of thirty-six thousand deaths a year in England and 
Wales, which I attributed to true pulmonary consumption five 
thousand might be saved by increased space and improved 
ventilation in shops, work-shops, and factories; that among 
men doing the same work under the same roof, the liability to 
consumption was determined by the space, and that this might 
be narrowed to a point at which men would die as fast as by 
some contagious malady, so that here, as in Italy, consumption 
might seem to pass from one person to another." According 



MEDICAL, AND 8UEGI0AL ESSAYS. 37 

to Dr. Parkes, the extraordinary amount of consumption which 
prevails among the men of the royal and merchant navies, 
and which in some men-of-war has amounted to a veritable 
epidemic, is in all probability attributable to faulty ventila- 
tion. I have remarked the same excess of tubercular disease 
of the lungs in our own naval service, and injustice has undoubt- 
edly been done in many cases of phthisis pulmonalis which 
were certified " not to have occurred in the line of duty," but 
assumed to have had a remote inherited origin, when the 
disease was in fact directly attributable to the unwholesome 
and humid air they were compelled to respire, for the re- 
searches of Bowditch and Buchanan show that, independently 
of mere impurity of the atmosphere, there is a decided rela- 
tion of cause and effect between dampness and consumption. 
The nosological heading ''phthisis," on the quarterly report of 
-sick, often represents only advanced cases of the disease, and 
not all of these, many being carelessly recorded as bronchitis 
chronica, while a very large proportion of incipient pulmonary 
tubercle is simply classed as bronchitis acuta or catarrkus. Con- 
stitutional predisposition assuredly existed in some of these, 
but the majority might have escaped the development of the 
disease had they lived under proper hygienic conditions, espec- 
ially with regard to a sufficient supply of pure air. 

Notwithstanding the importance of this matter of ventilation, 
few officers trouble themselves about it further than to order 
the wind-sails set when the'weather is fine. These are certainly 
among the most important ventilating apparatus we possess, 
but they are seldom set in wet, cold, or very windy weather, 
although a large proportion of the crew is below at those times 
when the hatchways are also usually partly covered up. On 
many of these occasions they could be kept hoisted without 
inconvenience. They ought not to be lowered at every fresh 
breeze or rain-squall. A fire-tub placed under the foot of the 
wind-sail and watched, would prevent the deck from becoming 
tiooded with water, and in cold weather the men had better 
protect themselves by extra clothing, than keep warm by 
confining and corrupting the atmosphere ; for though the human 
odor is not perceptible when the temperature is low, the air is 
still loaded with organic matter, and disoxygenation and the 
exhalation of carbon dioxide go on as at other times. Steam- 
ships are now generally heated by coils of steam-pipes, and if 
proper apertures are provided for the discharge of the heated 



38 MEDICAL AND SURGICAL ESSAYS. 

and access of fresh air, they become excellent aids to ventila- 
tion. Wind-sails, of which there cannot be too many, require 
to be carefully watched while set. They should always be 
accurately trimmed to the wind, kept free from bends and 
fastened down not more than a foot from the deck, never 
triced up by a lanyard to the beams. When this is done, those 
men who sleep exposed to the currents of air through them are 
apt to contract catarrhal affections. The bottom piece, some- 
times added for ornament, should always be removed, a hoop 
taking its place, and large fenestrated openings being made 
in the sides of the wind-sail above the hoop. They should be 
hoisted however light the air, even in calms, when all the fore 
and aft sails should be set and their sheets hauled as flat as 
they can be got, not merely to assist in steadying the vessel, 
but to create a movement in the atmosphere through the 
rolling of the ship. In narrow rivers and inlets, ships at 
anchor should be sprung to the wind whenever feasible, the 
broadside of the vessel with its numerous apertures affording a 
very much greater surface for the admission of air than the 
bows, and the wind-sails not operating to becalm each other 
as when the wind is right ahead. On some stations, as Japan, 
this is a subject of stringent regulation on board the British 
men of-war. A scuttle admitting a wind-sail or ventilator 
should always open into the sick-bay and yeoman's store-room, 
the latter the worst ventilated apartment in the vessel, its 
atmosphere being rendered still ifiore inrptire by one or two 
lights kept constantly burning. When it is absolutely neces- 
sary to cover them, light iron gratings over all the hatchways 
are better than the ordinary heavy wooden covers or gratings, 
being more easily cleaned, and allowing larger apertures for 
the admission of air. When sailing vessels are under way 
with courses and spencers set, powerful currents of air are 
directed downward through the open hatches. In steamers 
this is, in a measure, compensated for by the upward current 
induced by the elevation of the temperature of the engine- 
room atmosphere ; but during the long anchorages in port, and 
especially during calm weather, when wind-sails are of little 
service, the galley-fire, should it be located on the berth-deck, 
is the only means for exciting motion in the stratum of air 
below the level of the lowest line of air-ports. Two or more 
large iron ventilating pipes or funnels, like those in use ou 
board passenger steamers, and in the Navy communicating- 



M.EDICAL AND SUBGHCAL ESSAYS. 39 

with the fire-room of steam-vessels, should open on the berth- 
deck. In severe gales it is occasionally necessary to batten 
down all the hatches, closing every aperture by which air or 
water can enter, and at other trine, except a small scuttle in 
the main and steerage hatches. In such cases the atmosphere 
soon becomes unfit for respiration, and much suffering is 
occasioned and danger incurred by the sick, and those whose 
duties confine them below. Much of this inconvenience, as 
well as that experienced during the long rainy seasons of so 
many of the stations of our naval vessels, from covering the 
hatches and skylights, would be obviated by ventilatiug-fun- 
nels, projecting six or eight feet above the spar-deck and fitted 
with movable cowls, carefully adjusted to the wind. When 
the hatches are battened down, both watches should be kept 
on deck, and the watch off duty allowed to sleep on the poop 
or other convenient dry place. The officers should also be 
required to remain in the open air, and the bed-ridden sick be 
removed to the spar-deck cabin, or to some equally sheltered 
and ventilated place when there -is no such apartment. 

Nor is this all that can be done toward ventilating a vessel. 
It is not merely sufficient to provide for the admission of fresh 
air, but that which is impure should be removed. It is dis- 
creditable to the mechanical ingenuity of our country that so 
few attempts have been made to devise machines which can 
effect this double purpose. On board steamers the problem 
would seem to be very easy of solution, air being propelled 
through a system of pipes traversing the vessel, and even kept 
in motion by punkaps or fans operated by the machinerj- when 
under way, or by a donkey-engine when at anchor. The officers 
of the French navy have taken the lead in this matter, com- 
manding as well as medical officers having interested them- 
selves in it. The apparatus of Captain Brindejonc and that 
of M. Peyre, though both of small size, are fully able to accom- 
plish the objects proposed. The principle of the first is the 
same as that of the ordinary rotary fan ventilator, recently 
placed on board some of our vessels, a series of fans being- 
made to revolve by means of a crank, in a cylinder, from which 
canvas tubes lead above and below for the admission and dis- 
charge of air. Though occupying but a small space and em- 
ploying the labor of but one or two men a few hours everyday, 
it is able to effectually supply every part of the vessel with 
fresh aii\ I have been attached to but one vessel in the Navy 



-10 MEDICAL, AND SURGICAL ESSAYS. 

which has been provided with this apparatus, and even on 
board this ship, not withstanding my repeated recommendations, 
it was only put in operation on two or three occasions, and 
then principally as a punishment for black-listers. Certainly, 
as a system of punishment, it is better to employ men at this 
work than, as may be daily seen, at polishing round-shot, scrap- 
ing, painting, and rescraping iron stanchions, walking up and 
down the deck carrying heavy loads, or sitting idly in the brig 
with their hands and legs ironed, rejoicing in their exemption 
from labor. Simple as is this apparatus in its construction, it 
is necessary to pay attention to the freedom of the tubes from 
bends and to the direction in which they are led, while to pro- 
duce a current of sufficient velocity, that is, one moving at least 
two feet per minute, the cranks should be turned with consid- 
erable rapidity. If two apparatus are put in operation at the 
same time, as is desirable, one should be used forward and the 
other aft, the one discharging air from below, while the other 
forces it from above, reversing the direction of the currents 
every hour. 

A captain in the French navy has devised a system of stowage 
known as the "Arrimage Lugeol," by which the flour, salt pro- 
visions, bean-lockers, rigging, and every other substance in the 
hold subject to decomposition, are surrounded by aeriferous 
canals. By wind-sails or ventilators introduced into these 
passages, currents of pure dry air may be distributed through 
every part of the vessel, thus not only contributing to the 
health of the crew, but also to the preservation of the provisions 
and other destructible stores. Such vessels are less apt to be 
overrun by roaches and other vermin, which are active sources 
of offensiveness. As our own vessels are constructed, all that 
can be done is to open the spirit-room, holds, sail-room, &c, 
every few days in pleasant weather, lower wind-sails into them, 
and at other times renew their atmosphere by the fan ventila- 
tors. 

The private mess-stores of officers contribute greatly to 
vitiate the air of the lower decks. The ward-room, pantry, and 
the various store-rooms on the berth-deck and orlop contain 
eggs, fresh meats, and vegetables, which decompose rapidly 
and become very offensive. These rooms should all be accessi- 
ble to air, through numerous openings in the bulk-heads, and 
they should also be opened and ventilated several times a week. 
I have already suggested the desirability of latticing all the 



MEDICAL AND SURGICAL ESSAYS. '41 

bulk-heads on the berth and gun decks to permit the free circu- 
lation of air forward and aft. 

If proper attention is paid to these points, there will seldom 
be occasion for the employment of chemical disinfectants. 
Dryness, cleanliness, and ventilation are the most powerful dis- 
infecting meaus. The holds, spirit-room, and store-rooms for 
provisions should be whitewashed every month, as well as all 
casks which are stowed below, and whenever these are broken 
out for the purpose of taking an inventory or for cleaning the 
hold, they should be swept and re-whitewashed. Whitewash 
should also be used on the berth-deck beams and bulk-heads 
instead of paint. By absorbing carbon dioxide, it assists in 
purifying the air. Lead nitrate, chlorinated lime and soda, 
carbolic acid, &c, are never more than aids to proper ventila- 
tion. They cau never be carried in bulk sufficient to be ser-. 
viceable alone, and, besides, their effects are only temporary. 



Light is a powerful vital stimulant. Removed from its influ- 
ence both plants and animals lose color, strength, and firmness 
of tissue. " Of all the elements which play a high part in the 
material universe, the light which emanates from the sun is 
certainly the most remarkable, whether we view it in its sani- 
tary or scientific relations. It is, to speak metaphorically, the 
very life-blood of nature, without which everything material 
would fade and perish. Man in his most perfect type is doubt- 
less to be found in the regions of the globe where the solar 
influences of light, heat, and chemical rays are so nicely bal- 
anced. Under the scorching heat of the tropics man cannot 
call into exercise his highest powers. The calorific rays are all 
powerful therej and lassitude of body and immaturity of body 
are its necessary results ; while, in the darkness of the polar 
regions, the distinctive characters of our species almost dis- 
appear in the absence of those solar influences which are 
so powerful in the organic world.'' — (Sir J. Ranald Martin.) 
According to Dr. Edwards, the proper development of the 
body depends upon its free exposure to sunlight, absence of 
which he considers one of the external causes of those deficien- 
cies of form seen in children affected with scrofula. 

The greater part of the crew of a man-of-war has sufficient 
employment in the open air, but there are numerous individuals 
on board ship, whose special duties confine them below all day, 



42 MEDICAL AND .SURGICAL ESSAYS. 

who exhibit the pallid exsanguious appearance, the effect of 
habitually remaining in the dim twilight of the lower decks. 
All such persons should be permitted or, if necessary, com- 
pelled to go on deck and expose themselves to the sunlight 
every day. The sick and convalescent will improve more 
rapidly if kept on deck as much as possible, those unable to 
walk being placed in chairs or cots under the topgallant fore- 
castle, the break of the poop, or quarter-deck awning. 

All the lower decks will be better illuminated by thick plates 
of glass set in the deck overhead. The only objection that can 
be opposed to them is that they are apt to leak, but this can 
easily be remedied by a renewal of the setting. 

Artificial light is more injurious than beneficial. Every lamp 
and candle is an active consumer of oxygen, and therefore con- 
tributes to vitiate the air. Hammond'^ experiment shows that 
a single good sperm candle, burning at the rate of 135 grains 
an hour, will produce 9,504 grains (nearly G9 gallons or 11.6 
cubic feet) of carbon dioxide in twenty -four hours ; and as many 
candles burn faster and produce more carbonic acid gas, it is 
within the bounds of fact to say that a candle, while burning, 
in the main causes as great a deterioration of the atmosphere 
as an adult person breathing in it during a similar length of 
time. Hence the minimum number of lights absolutely neces- 
sary should be placed on the berth-deck, and these always 
under open hatchways, that the upward current of the heated 
gaseous products of their combustion may assist the ventilation 
of the deck. Those officers who confine themselves to their 
rooms, not only experience the pernicious effects of breathing 
an impure atmosphere, but have their sight impaired by the 
flickering blaze constantly near their eyes. Deck lights of 
thick glass over their apartments w 7 ould often enable them to 
dispense with the use of candles. 

Another advantage attending the employment of whitewash 
on the berth-deck, besides its effect in purifying the air, is that 
it multiplies the light admitted by the ports and hatchways. 
All the furniture of officers' apartments and of the ward-room 
should be painted white, the otherwise unpleasant uniformity 
being relieved by a little gilded molding or ornamental decora- 
tion with bright colors. On the spar-deck an excess of white 
or metal bright-work is objectionable, and should give place to 
light-blues, greens, or yellows, or to the natural color of the 
wood. 



MEDICAL AND SURGICAL ESSAYS. 43 

CLOTHING. 

Every man in the Navy should be required to possess the 
following articles of clothing: 

One waterproof cap. 

One water-proof pea-jacket. 

One pair of blue cloth trousers. 

Two pairs of blue satinet trousers. 

Three blue flannel overshirts. 

Four blue flannel undershirts. 

Four blue flannel drawers. 

Three white sheeting frocks. 

Three pairs of white duck trousers. 

One blue flannel juniper. 

Four pairs of woolen socks. 

One pair of boots. 

One pair of shoes. 

One straw hat. 

One black silk neckerchief. 

One mattress. 

Two blankets. 

Of which there should be supplied to the recruit, as an outfit, 
the pea-jacket, cap, neckerchief, shoes, mattress and blankets, . 
one pair of cloth and one of satinet trousers, a flannel overshirt, 
two undershirts, two pairs of drawers, and two of socks. Al- 
though only these things may be required at the outset, it is 
indispensable that the remainder be obtained as soon thereafter 
as possible, that the proper changes may be made in the event 
of getting wet. The British admiralty, with a view of lessen- 
ing the indebtedness which men have to incur on entering the 
service, has authorized the gratuitous presentation to certain 
recruits of a blue cloth jacket and pair of trousers, a blue serge 
frock, a white duck frock and trousers, a black silk handker- 
chief, and a pair of shoes. 

Many sailors prefer to buy the materials from the paymaster 
and make their own clothing, being able to fit themselves better 
and to sew them together more neatly and enduringly. This 
affords occupation for the crew, and should, if only on that 
account, be encouraged. One of the most interesting spectacles 
presented on board a mau-of war is that of groups of men seated 
on their ditty-boxes between the guns busily sewing. 

I have restricted the number of white clothes because thev 



44 MEDICAL AND SURGICAL ESSAYS. 

are seldom worn, on board some vessels never, and ought to be 
abolished. Their chief use is as a Sunday morning mustering- 
dress in the tropics, but in recent years the whim of the execu- 
tive officer of the flag ship, or in its absence, of the vessel, 
determines whether the dress shall be white shirts and pants, 
blue shirts and white pants, white shirts and blue pants, blue 
shirts and pants, apparently more for the sake of variety than 
anything else, straw hats and blue caps, with or without white 
covers, extending the number of permutations. The absurdity 
of requiring a man to clothe his legs in flanuel and his arms in 
white duck to-day, while to-morrow he is blue above and white 
below, ought to be evident to even the non-professional, as it 
is to the old quartermaster whose " rheumatiz" is made to shift 
from his shoulders to his loins and back again; but I have 
known ships on board which the daily dress-signal followed the 
card as regularly as the paymaster's stewards did in issuing 
the appropriate ration for the day. Whether white is or is not 
worn, under no circumstances, in no climate, ought the sailor 
to omit wearing flannel next the skin. This is a hygienic meas- 
ure of the utmost importance, and should invariable be insisted 
upon. The flannel abdominal belt has been recommended as a 
substitute, but it is difficult to keep in position, and while doubt- 
less of great benefit where dysentery is apt to occur, does not 
offer the same protection against pulmonary complaints and 
malarial diseases as the complete flannel suit. The single argu- 
ment in favor of white is that it absorbs and transmits less 
solar heat, and is therefore cooler than blue; but if worn for 
this reason, the whole suit should be white and made of flannel, 
for the additional woolen under-clothing will more than coun- 
terbalance the advantage of the light-colored outside garment. 
The white dress as now worn is a useless expense and an un- 
necessary addition to the bag, and boys and landsmen will 
elude observation and wear no other clothing. In very hot 
weather both flannel under and overshirts may be left off and 
a neat tight flannel jumper substituted. If caps are worn in 
the tropics, they should be covered with white, but a light 
straw hat is the proper article of head gear. The weight of the 
coarse sennit hat made on board ships is objectionable. If men 
are sent aloft or exposed to the sun on deck in the tropics, 
they should be advised to put wet handkerchiefs or cloths inside 
their hats. 
Neatness and cleanliness of dress are always to be inculcated. 



MEDICAL AND SURGICAL ESSAYS. 4.1 

Clothing should "be kept in order. The custom of allowing men 
to have their bags on deck once a Aveek, usually on Saturday, 
should be universal, and departed from only in emergencies. 
Clothes lockers have been proposed as substitutes for bags, but 
the change is not desirable. The latter are more convenient, 
protect the clothes better from dampness, and can be taken on 
deck and their contents exposed to the sun and air. "They pre- 
vent the accumulation of dirt, unavoidable in lockers, and a 
not less important advantage is that they do not encroach so 
much on the air-space of the vessel. Their removal on deck, 
when the berth-deck is cleaned, allows the access of air to their 
racks. Ditty-boxes or bags are conveniences which every man 
should be permitted, preferably the former, siuce they can be 
arranged not only for sewing articles, shaving utensils, trinkets, 
and writing-materials, but may also serve as desks and stools. 

It would be well for the Government to supply them of uni- 
form size, numbered with the bags, and when not in use care- 
fully stowed away in racks assigned for them. 

The sailor can easily be taught habits of order and regularity. 
In a well-disciplined man-of-war the whole crew soon acquires 
them. If a berth-deck is always dry and clean, every bag and 
ditty-box in its place, the master-at-arms will have A 7 ery little 
trouble with the men themselves. A few lazy, worthless fel- 
lows, however, if allowed to go unchecked, will inconvenience 
and confuse all the rest. The berth-deck is the mau's home ; 
his bag and ditty-box are to him what the privacy of the officer's 
room is to the latter, and it is, therefore, proper that he should 
enjoy as much comfort there as is possible under the peculiar 
circumstances of his life. 

Under-clothing should be frequently changed. This does not 
require argument, and it is a matter to which not the slightest 
attention is paid in the service. The officers' servants, lands- 
men-, and many of the foreigners in the crew are habitually 
unclean, both in person and dress, and require careful super- 
vision. Few of them provide themselves with proper outfits 
except by compulsion. They will keep a clean mustering suit, 
which they remove immediately after inspection, and a few 
clean articles in their bags to satisfy the quarterly examination 
of their contents, and will wear the same pair of drawers and 
socks for months. One of the most important duties of divis- 
ion officers is to attend to their men being properly provided 
with clothing, and it is equally important that, at every morn- 



46 MEDICAL AND SURGICAL ESSAYS. 

iug inspection at quarters, they should ascertain whether they 
are cleanly clad. It will soon be evident which men are habit- 
ually clean and neat, and which will require examination. 
Sufficiently frequent opportunities should be allowed for wash- 
ing and drying clothes. At sea, unless the weather is very 
bad, this may be done daily ; in port, twice a week. New navy- 
blue flannel requires frequent washing before the color ceases 
to come out, and men's skins and blankets are usually dyed an 
intense blue for several weeks when this is not done. 

I have already insisted upon the necessity for keeping a ves- 
sel dry, and have indicated the means by which this object 
may be attained. I have omitted until this place to refer to 
the subject of damp clothing. Certain officers profess to believe 
it an attempt to make men delicate to insist that they .shall 
remove their wet clothes, and point to the impunity with 
which some men continue in thein for days. Where there is 
one such exception, there are many who succumb, sooner or 
later, and appear at the sick-bay. The French Departement de 
la Marine has not considered this matter unworthy of its inter- 
ference. The ordinance of August 15, 1851, prescribes that the 
watch officers shall see that the men do not keep on their wet 
clothes when their watch is over, and that they shall enter on 
the log all such accidental changes of dress. In bad weather, 
when the watch is piped down, and at all times when boat's crews 
return wet, let them be compelled to remove their wet clothes 
and deposit them in fire-tubs. The provision of outfit which 
I have recommended will allow three changes. Should the 
rain continue, and no occasion offer for drying the wet clothes, 
let each man remove his damp undershirt and trousers on 
turning in, and hang them on his hammock-hooks, to resume 
them when he returns on deck. Men should not be allowed to 
expose themselves needlessly. Every one should be provided 
with a water-proof overcoat, and if the weather is not cold, be 
required to remove shoes and stockings. If too cold to go bare- 
foot, boots should be worn. Similar precautions about wet 
feet should be exacted while washing decks. Few old sailors 
keep on their' shoes when at this work, but landsmen and mer- 
chant sailors shipped for the first time, too lazy to take them 
off, will not do so unless compelled. 

PERSONAL CLEANLINESS. 

Occasionally a man notoriously filthy is ordered to be 
scrubbed in the head, or the negro servants are inspected during 



MEDICAL AND SURGICAL, ESSAYS. 47 

the morning watch by the master-at-arms ; but beyond this, I 
have never witnessed nor heard of any inquiry by officers into 
the bodily condition of the crew. If a man's cutlass is bright 
and his overshirt clean, the inspecting officer is satisfied, 
although his axilla 1 , groins, and perinamm may be abominably 
dirty and verminous, his undergarments unclean and unchanged 
for weeks, and his bedding disgustingly foul and offensive. 
Even when some one with sensitive nostrils has obtained an' 
order for the daily inspection of the ward-room boys, they are 
only compelled to strip to the waist, and if the collars of their 
shirts and wristbands are not very much soiled, they are pro- 
nounced clean, although their genitals, buttocks, and thighs 
have not been touched with water during the whole cruise. I 
have known officers' servants to come under treatment at the 
sick-bay, and to be discovered to have worn the same pair of 
drawers, night and day, for months. 

It is not altogether the fault of the men that this is so. The 
human beast requires to be taught to be cleanly. Physicians 
know that sordid bodies, as well as sordid minds, are found 
even among the possessors of wealth and the occupants of 
prominent stations in society. Bring the rude, illiterate sailor, 
therefore, on board ship, still reeking with the foulness of the 
slums wheuce the land-shark has beguiled him, compel him to 
live, eat, and sleep uncleanly, deprive him of every semblance 
of personal comfort, never appeal to his reason or intelligence, 
but teach him that he is nothing but a slave or beast of burden — 
what result may be expected ? Seamen are naturally care- 
less. Left to themselves, they will neglect themselves. Some 
few men-of-war's-meu are exceptions, but the great majority of 
patients admitted into the naval hospitals from before the mast 
are shamefully unclean. Always the first, and sometimes the 
only, prescription they require is a warm bath and clean shift 
of clothing. What physician would ever think of attempting 
to accomplish a diaphoretic effect upon the begrimed, callous, 
hide-like cuticle of most sailors, until lie has dissolved off as 
much as possible of it with warm Water and soap, or borax? 
Yet I have heard officers frequently joke about the appearance 
of these dirt-encased fellows, and laughingly describe them as 
"veritable old shell-barks," or as "covered with barnacles.'' 

Ninety per cent, of the men presenting themselves at the 
naval rendezvous are filthy in person, and every medical officer 
should refuse to examine them in such a condition ; and even 



48 MEDICAL AND SURGICAL, ESSAYS. 

after passing them lie should direct them to bathe again before 
reporting on board the receiving-ship, otherwise they will 
remain dirty, will be transferred to some sea-going vessel in 
the same state, vermin on their bodies and in their hair, and 
they will continue so until they are discharged or become sick 
and are sent to a naval hospital and subjected to a compulsory 
bath. 

When swimming is possible or allowed, usually about twenty 
or thirty of the crew avail themselves of it as a diversion, but 
months sometimes intervene between these opportunities. The 
usual time for washing is during the morning watch, after the 
decks are holy-stoned. Some of the men strip to the waist, 
and wash their necks, -arms, breasts, axillae, and feet, but the 
greater number do not. Scarcely any ever cleanse their thighs, 
groins, or buttocks. Officers of divisions are responsible for 
the uuclean condition of their men. They should require them 
to present themselves at the morning inspection, not only with 
clean outer apparel, but with clean underclothing and clean 
skins. They can perform this duty without any abasement of 
dignity. It is less disagreeable for the division officer to make 
this inspection than for the medical officer to introduce his 
finger into that same officer's rectum, if he has fistula ani, or to 
labor by the hour to dilate his strictured urethra. Mauy duties 
are unpleasant, but the object in view should reconcile us to 
thgir performance. Very properly in ports where prostitutes 
are subjected to examination, no man is allowed access to them 
until the medical officers are satisfied of his own exemption 
from venereal disease, and no greater outrage is committed 
upon the man's modesty when he is required to satisfy the offi- 
cer of his division that he is clean in person. False modesty 
cloaks both vice and dirt, and the man who makes the loudest 
outcry about outraged sensibilities will be found to have the 
strongest reasons for avoiding exposure. Habitually clean 
men will very soon be discovered and relieved from examina- 
tion ; others wiil be shamed into an attention to their persons 
that they had never been taught at home nor seen practiced 
elsewhere; while the incorrigibly foul will be isolated and 
cleansed by force. It is not proposed that the men at quarters 
should unbutton their pantaloons and submit to a close scrutiny 
of every square inch of their surfaces every day, but their spare 
underclothing should be frequently and carefully inspected. 
Provision should bi 1 made to allow general ablution bv every 



MEDICAL AND SURGICAL ESSAYS. 49 

man on board, and the divisional officer should satisfy himself 
in as private and delicate a manner as possible that this has 
actually and thoroughly been done. iSTo man should be allowed 
to remain, as is often the case, for weeks with his skin of a deep 
blue color from the dye-stuff of his rarely washed new flannel 
shirt and draws, and, in tropical climates, daily general ablu- 
tion should be exacted of every member of the crew. If objec- 
tion is made to the construction of a proper permanent bathing 
apparatus, a large tire-tub may be placed under the top-gallant 
forecastle, or in the manger, or in some other convenient situ- 
ation, and -surrounded by a screen, or the head-pump may be 
screened at certain times in the day and devoted to this pur- 
pose. In vessels where condensed water can be obtained in 
quantities, this should be used in preference to salt-water. 
Every man should be required to possess one or more towels, 
which should appear among the paymaster's stores, and facili- 
ties should be afforded every day for drying them. If a " sweat- 
rag/' as the little piece of sheeting is termed, which some men 
use, is now seen flying anywhere to dry it is immediately 
ordered down, even while the spans of the quarter-boats are 
fluttering with officers' towels. When the clothes-lines are not 
up, the men usually spread their sweat-rags upon their 
shoulders and back, and dry them there. 

The hair, beard, and teeth are all neglected on board ship. 
It would be a difficult matter to compel old sailors to cleanse 
their teeth, but all the boys should be obliged to purchase tooth- 
brushes and to use them regularly. 

Firemen and coal-heavers should be compelled to bathe every 
day, when the vessel is steaming, but not immediately after 
quitting their stations. Cardiac diseases, pulmonary affections, 
acute inflammations, &c, are common among this class from 
their imprudent exposure to cool draughts, and from washing 
with cold water while their bodies are heated. The engineer 
on duty should attend personally to the disposition of men who 
come off watch, aud not allow them to bathe, nor to throw 
themselves under the ventilators until a proper time had 
elapsed. 

FOOD. 

No objection can be urged against the quantity of food fur- 
nished by the Government, nor, if inspectors continue to do 
their duty as faithfully as at present, to its quality. That 
enough is supplied by the ration is evidenced by the amount 

4l 



50 MEDICAL AND SURGICAL ESSAYS. 

thrown overboard by the cooks, and by the fact that there are 
few messes which do not commute one or more of their rations. 
The Government authorizes this to the extent of two rations 
for every ten men. It is idle to speculate upon the amount of 
carbon, oxygen, hydrogen, and nitrogen required to supply the 
waste of the body, and to endeavor to arrive, by chemical 
analysis, at the precise number of grains a man should be given 
to eat. The molecular waste of tissue depends upon climate, 
physical exertion, and health ; but the naval ration undoubt- 
edly supplies the maximum under any circumstances. The 
robust appearance of an American man-of-war's crew attests 
this fact, as do the zest and exclamations of surprise and delight 
with which foreign sailors partake of it when iuvited. In the 
French navy each man receives less than half a pound (214 
grams) of meat a day, and only 3.3 pounds (1,500 grams) of 
animal food, (beef, bacon, and cheese,) and 1G.5 pounds (7.5 kilo- 
grams) of vegetable substances (beans, peas, and rice) a week. 
In the American service each man gets every week from six 
and a half pounds of the former (beef, pork, and preserved 
meats) at sea, to eight and three-quarters pounds of fresh meat 
in port, and eleven of vegetables, (beans, rice, flour, dried fruit, 
desiccated potatoes, and mixed vegetables,) with a liberal 
allowance of sugar, molasses, vinegar, and pickles. This ration 
has been instituted sufficiently long for its effects upon the 
health on long cruises to be manifested. That the former 
ration was not exactly what the human body required for its 
healthy maintenance was evident from the disturbances occa- 
sioned by its persistent use; but on two days, on which salt 
beef and rice were then served out, preserved meats and vege- 
tables are now substituted. The change leaves scarcely any 
other improvements to be suggested, except a more frequent 
issue of preserved beef or other meat in lieu of salt, an increase 
in the allowance of coffee and butter, and a further extension 
of variety in vegetables by the occasional substitution of 
peaches, sauer-kraut, and cranberries for dried apples. With 
these exceptions it is probably the best that can be devised, 
for temperate climates at least, to meet all the requirements of 
economy of space, capability of resisting decomposition, paya- 
bility and alimentariuess, until experiments now being made 
with the object of preserving fresh meat by the abstraction of 
its moisture, allow the total abolition of salt meat as an article 
of diet. Dr. Alexander Rattray, surgeon royal navy, in an ad- 



MEDICAL AND SURGICAL ESSAYS. 51 

mirable report published by tlie admiralty, in their annual vol- 
ume on the health of the British navy, has called attention to 
the injurious consequences of the use of salted meat, winch he 
correctly styles an unnatural form of food, and which he recom- 
mends to be almost entirely displaced by preserved meat. 
Commanding' officers should eagerly embrace every occasion of 
going into port or of speaking vessels at sea to obtain supplies 
of fresh meat and succulent vegetables. One pound and a 
quarter of fresh or three-quarters of a pound of preserved meat, 
which should not always be beef, may be substituted for a pound 
of salt, one pound of soft bread or of flour for the daily allowance 
of ship biscuit, and fresh vegetables not to exceed in value the 
dried. When the stay in port is prolonged beyond a fortnight, 
salt food may be issued twice a week. Dr. Rattray has pro- 
posed a radical change in the British naval dietary, arranging 
it for temperate and tropical climates for harbor and for sea. 
One prolific source of the disease in the navy in notoriously un- 
healthy tropical stations is the neglect to adapt the diet, dress, 
and labor to the necessities of the climate. Englishmen have 
been performing a great physiological experiment for many 
years in every quarter of the globe in their extensive colonial 
dependencies. Carrying their national customs wherever they 
have intruded themselves, they have dressed, eaten, slept, and 
generally lived as they were accustomed in their own foggy 
island, with results that are now matters of scientific history. 
The red-coated, leather neck-cased, overladen soldier is not so 
often seen marching under a midday Indian sun ; but despite 
all lessons, the wealthy Britisher, male and female, dines at 
seven off as many courses, drinks beer and brandy and soda, 
and goes home with "liver." The Japan Weekly Mail of Yo- 
kohama, for August 1-. 1871, refers to a recent instance of cul- 
pable violation of sanitary laws by military authorities, for 
which the medical officers were in no way responsible, in the 
following terms : 

Tbe old story again ! The weary old story of life sacrificed, but sacrificed 
for nothing — to appease no gods; to propitiate no demon ; to gain no laurels; 
to chastise no enemy ; to procure no benefit ; to afford no example ; to 
inspire no devotion. Any moderately sensible judge of human affairs might 
have dreaded some such a catastrophe as has overtaken the Tenth Regiment 
and the newly-landed battalion of marines, which lias arrived to relieve it. 
The regiment is moved in marching order in tbe heavy clothes which a 
tropical climate converts into shirts of Xessus, witli knapsacks, arms, and 
full paraphernalia. They may have been moved on empty stomachs, but 



52 MEDICAL AND SURGICAL ESSAYS. 

what with parade, the march to the quay and the time required for getting 
on board, they are for three hours exposed to the sun before they get food 
or arrive under the shelter of an awning. Meanwhile the plague has 
begun. The full-blooded men are smitten with heat-apoplexy, and the 
wonder is that more do not succumb to the enemy. Three good men fell 
victims to that march — men who had been long in the regiment, and who 
might have lived to feel the pride of belonging to it. On the same day the 
marines, who have replaced them, come under the same fatal influences. 
Three were struck down. One is dead, others are iu a dangerous state, and 
their recovery doubtful. Now it is clear that codling soldiers is absurd, but 
yon cannot inure men to a hot sun by exposing them to its deadly rays. 
You may gradually acclimatize them, and after all this you must handle 
them iu the sun as in the presence of an enemy whom you may, With certain 
precautious, defy, but whom you cannot conquer. You must avoid him to 
the uttermost. In war it may be necessary to face him ; in peace it can 
hardly be so. The whole question is one of management and administra- 
tion. The regiment was incontestably in good order ; but why was it 
moved in August, with the thermometer at ninety, and the ominous 
typhoon-fly hovering about ? 

It is a physiological impossibility for the sailor at Singapore, 
Batavia, Hong-Kong, or Marauham to eat the same kind and 
quantity of food as at Kittery or Boston, where he shipped, and 
remain healthy and efficient. Messes in the tropics should, 
therefore, be allowed, advised, and encouraged to commute 
parts of the ration of meat for vegetables, especially rice, at sea, 
and for fruits and fresh vegetables when in port. Most messes 
stop one or more entire rations and draw their value in money, 
either to pay their several cooks, which should be prevented 
by not allowing steady cooks, or to create a fund for the pur- 
chase of potatoes, turnips, onions, or other vegetables as sea- 
stores, which should be encouraged and conveniences afforded 
by the authorities of the ship for their storage in the boats, un- 
der the boom-cover, or elsewhere on the spar-deck. They enter 
into the composition of the morning " scouse," which is the favor- 
ite dish of the sailor, and they are better antiscorbutics than 
anything iu the dispensary. When one has been a month at 
sea a roasted " spud " (potato) is relished with an avidity that 
only a man starved of his natural aliment can experience, and 
a plentiful supply of this vegetable will render unnecessary any 
large pro vision of lime or lemon juice, or any other medicinal 
antidote to scurvy. It is commonly but erroneously believed 
that this disease has disappeared from the Navy. Medical In- 
spector Wilson, in his Naval Hygiene, relates two instances, 
during his experience, of the development of the scorbutic tend- 
ency on shipboard, the first occurring on the frigate Savannah, 



MEDICAL AND SURGICAL ESSAYS. 53 

on her return from California during the Mexican war, and the 
second on board one of the vessels of the Japan expedition dur- 
ing her passage from New York to the Straits of Sunda. I 
have also had to treat the disease, the first time while attached 
to the sloop-of-war Levant, which, as -in Dr. Wilson's second 
instance, was making a passage from New York to China via 
the Straits of Sunda, and again on board the Idaho in 1868, while 
en route for Japan by way of the Ombay passage. Short stop- 
pages were made in both cases at Eio de Janeiro and at Cape 
Town, but the crews were not allowed liberty on shore, and 
consequently did not experience that indescribable but marked 
benefit which undoubtedly results from simple contact with the 
earth, the deprivation of which may be ranked with the want 
of fresh vegetable food as one of the efficient causes of the dis- 
ease. The passage of the Levant was stormy, the men were 
exposed to continued rains and cold, their labor was arduous, 
and almost every article of the ration was badly spoiled. After 
a delay of only two days at Anjer, the ship resumed her course 
to Hong-Kong, where she arrived on the one hundred and eighty- 
third day from New York, a passage greatly exceeded by the 
Idaho, which did not anchor at Nagasaki until the two hundredth 
day. In neither of these cases did the disease manifest itself 
by those terrible symptoms formerly supposed to be essentially 
distinctive of it. There were few individuals who sought to be 
excused from duty, but the general condition of the whole crew 
was below par ; they performed their duties listlessly and slowly, 
and Mere cursed for being morose and lazy; they lost strength 
and appetite ; their bodies were covered with mottled discolor- 
ations; their gums were tender and bled easily, causing those 
who chewed to attribute it to the tobacco, for which they lost 
taste; scratches, woiinds, and bruises healed slowly or not at 
all ; and men, often of the finest normal physique, succumbed 
readily to trifling causes of disease. Large numbers were sub- 
sequently invalided, whose disabilities actually began at this 
time, and the actual money loss to the Government was far 
greater than would have been the expense caused by a few 
days' longer sojourn in port. 

In foreign ports, bumboats attend all vessels whose crews are 
permitted to draw any portion of their pay. A small allow- 
ance of money, conditional upon good behavior, should always 
be made for this purpose, since the men have no other way of 
obtaining the fruits of the countries they may visit, and which 



54 MEDICAL AND SURGICAL ESSAYS. 

in tropical climates ought to enter largely into their diet. 
Excessive indulgence, however, particularly on first joining a 
station, must be carefully guarded against. In some bumboats, 
which should always be inspected by the medical officer, that 
no unripe fruit nor other improper articles may be offered for 
sale, boiled eggs, broiled chickens, fried fish, steaks, &c, are 
prepared, which the sailor, cloyed with the unvarying boil of 
the coppers, relishes exceedingly and which it is highly proper 
he should be permitted to enjoy. A watchful and comprehen- 
sive hygiene neglects no occasion of catering to the native 
instincts of the body, in violation of which the seaman lives, 
and of recalling the customs of civilized lite from which he is 
unnaturally severed. 

Besides vegetables, eggs, properly packed, might be allowed 
to be purchased by the several messes as sea stores. They can 
easily be fried before the galley is given up to the officers' 
cooks, and they make a palatable morning meal. The practice 
of carrying live-stock to sea is of doubtful propriety. It encum- 
bers the decks, diminishes the air space, impoverishes the 
atmosphere, creates filth and becomes diseased, while it ben- 
efits a very small proportion of the persons on board. Fowls 
are more easily kept clean and healthy than other live food, 
but their flesh is not superior in flavor or nutrient properties, 
nor better relished even by the sick, than that properly canned. 
This is especially true of the poor emaciated sheep and calves, 
which are sometimes killed for food after six or eight weeks' 
fright and torture on board a rolling ship. An exception may be 
made in the case of the large green turtle, which, whenever 
obtainable, should be taken to sea to be made into soup for the 
whole ship's company. 

It seems to escape officers of the Navy that the cooking of 
the sailor's food has anything to do with its nutritive value or 
palatability. The ship's cook is appointed without any special 
questioning as to his ability to perform his duties, which, how- 
ever, are of the simplest character. Everything given the 
sailor is boiled in the coppers, except in port, when some of 
the mess-cooks, by arrangement with the cabin or ward-room 
cooks, succeed in getting a piece of meat or a fowl roasted. 
The craving of the sailor for change is shown by the popular- 
ity of scouses, which some commanding officers are thought- 
ful enough to encourage by allowing the range an extra supply 
of wood. Our galleys are not very commendable exhibitions 



MEDICAL AND SURGICAL ESSAYS. 55 

of American inventive talent. It is certainly not impossible 
to contrive an apparatus possessing facilities for roasting meat 
and baking bread. In this matter, as in every other within the 
province of hygiene, the French are far in advance of all other 
nations. The "cuisine distillatqire " of Peyer and Eocher 
combines an oven for baking with an apparatus for distilling 
fresh water from salt, the coppers being at the same time 
heated by the steam, winch is in process of condensation into 
fresh water. Freshly-baked bread, when properly made, ought 
to be substituted for biscuit whenever possible. 

It is the duty of the officer of the deck to inspect the dinner 
prior to the serving out at seven bells in the forenoon watch. 
As now conducted this inspection is a mere form. The ship's 
cook brings a mess-pan to the mast containing the choicest 
piece of meat from the coppers, which the officer of the watch 
inspects by cutting off a slice or two' as a lunch. This duty 
should be performed by some other officer, and the inspection 
should extend to all the messes and to all the food at every 
meal. The fresh soups are sometimes so badly made, the veg- 
etables not being half cooked nor the meat properly boiled, 
that it is common for sailors to attribute to them all their digest- 
ive irregularities in port; yet some cooks are so expert in mak- 
ing these soups that officers find them very palatable as their 
own noonday meal. At sea the same complaint is general with 
regard to bean soup. Sometimes this is due to the inferior 
quality of the beau itself, occasionally to the hardness of the 
water, but most frequently to the neglect to soak them properly 
(sometimes a whole day is necessary) in cold water and to boil 
them sufficiently long. Cooks often have the water in the cop- 
pers boiling before they add the meat for the soup, ignorant of 
the fact that the flavor and nutritious qualities of the soup 
depend upon the extraction of the soluble principles of the 
meat, which only takes place when it is put in cold water and 
that slowly heated. On " duff" days, it is very proper to boil 
the water before the beef is added, since it is thereby prevented 
from yielding all its nutrient qualities to the water and is con- 
sequently more tender, juicy, and palatable. The "harness- 
cask," in which the meat is thrown after it has been issued by 
the paymaster's subordinates, and where it remains until ready 
to go into the coppers, is often imperfectly cleansed and allowed 
to become dirty from the accumulation of stale brine. It should 
be thoroughly and carefully washed after every using, and the 



56 MEDICAL AND SURGICAL ESSAYS. 

master-at-arms should be required to inspect it daily with the 
coppers and all the cooking utensils at the galley and the mess- 
things of the berth-deck cooks. 

The tea and coffee especially require examination into the 
method of their preparation. Frequently they are such abom- 
inable mixtures that even the men refuse them, while there is 
no part of their ration of which they are more fond, none which 
is of greater importance to their well-being, nor any which is 
so. easily prepared. Tea water should be issued to the mess-, 
cooks boiling, not more than ten minutes before the hour for 
the meal, and the mess-kettle should be kept tightly covered 
until the beverage is served out. Coffee, properly, should be 
made by the ship's cook at the galley, and only issued a few 
minutes before breakfast is piped. As nutritive properties are 
of more importance to the sailor than delicacy of flavor and 
aroma, which he probably would not appreciate, it would be 
well to preserve a portion of the tea-leaves and coffee-grounds 
from each meal for addition to the ration of the following. 

The usefulness of tea, coffee, and alcohol, in the form of wine, 
beer, or whisky, as food stimuli or accessory food, has been sat- 
isfactorily established by Austie, Lankester, and others. An 
old writer, whose wisdom has never been questioned, epitomizes 
in Ecclesiasticus, chap, xxxix, v. 20, with a scientific precision 
to which the learning of nearly thirty centuries has but little 
to add : ''The principal things for the whole use of man's life 
are water, fire, iron, and salt, flour of wheat, honey, milk, and 
the blood of the grape, and oil and clothing;" adding signifi- 
cantly in v. 27, "All these things are for good to the godly; so 
to the sinners they are turned into evil." The frightful conse- 
quences of intemperate indulgence in alcoholic liquors have 
resulted in the abolition of the spirit portion of the ration. If 
the substitution of a pint of beer or half a pint of wine for the 
gill of spirits, which the Department used to authorize, could 
have been effected, there is ho doubt of the propriety and ben- 
efit of its issue. The objectionable feature of the old service of 
grog was that it was drank undiluted and upon an empty stom- 
ach. The moral argument that it engendered and fostered a 
fondness for intoxicating liquors applied only to boys and a 
few landsmen, most sailors, firemen, and marines having already 
acquired the taste and habit before entering the service. It is 
doubtful whether even three years of enforced total abstinence 
could destroy the appetite in the confirmed inebriate. In such 



MEDICAL AND SURGICAL ESSAYS. 57 

cases the land-shark and prostitute can nullify in half an hour 
the resolutions of years. There are few medical officers in the 
Navy whose experience cannot furnish instances of officers of 
rank and education who have repeatedly violated the most sol- 
emn pledges and oaths to abstain from rum-drinking-. Liberty 
on shore is so frequent, and the license allowed drunkenness on 
such occasions, through the neglect to punish its habitual occur- 
rence, so general, that the mere abolition of the grog ration has, 
probably, accomplished little toward the checking of intemper- 
ance on board ship. Even under the old system, the opportu- 
nity to commute the grog for money to be spent in the bumhoat 
or on shore was extensively embraced. On board a sloop-of- 
war having a complement of one hundred and sixty men, I have 
known only forty to drink their grog. Fortunately, tea, coffee, 
and tobacco, to a large extent, accomplish the same results as 
alcohol. Under their use the sailor better endures fatigue and 
the vicissitudes of climate, is more cheerful in mind, is better 
nourished, and in tropical regions experiences less desire to eat 
an excess of meat. Gasparin long ago called attention to the 
fact that the Belgian miners performed their arduous toil and 
maintained their robustness and health with a diet notoriously 
scant, in consequence of the daily use of coffee; and Austie 
has adduced numerous instances "where the support of the 
organism, in the absence of ordinary food, by stimulants, (that 
is, agents which, by their direct action, tend to rectify some 
deficient or too redundant material action or tendency,) is one 
of the most remarkable phenomena which can be offered to the 
attention of the physiologist." Von Tschndi relates that an 
Indian, sixty-two years of age, worked for him (at excavation) 
for five days and nights consecutively, without any ordinary 
food at all, and with a very short allowance of sleep, and yet, 
at the end of that time'was fresh enough to undergo a long 
journey, simply because he was supported by the coca, which 
he chewed from time to time. He declares that the moderate 
eaters of coca are long-lived men, and that they perform ex- 
tremely hard labor, upon a very little food, as miners, soldiers, 
&c, and he mentions the fact that the custom of coca-chewing 
is of immemorial antiquity in Peru ; and Austie adds: "Next, 
perhaps, to coca, in its power of replacing ordinary food, we 
must reckon tobacco, and next to tobacco in efficacy as a sup- 
plementary food, and far surpassing it in its effectiveness under 
certain circumstances, is alcohol." I do not desire to advocate 



58 MEDICAL AND SURGICAL ESSAYS. 

the reissue of a daily ration of grog. Provision, however, 
should be made for its proper use in emergencies, as when the 
crew are exposed to a long continuance of bad weather, and 
especially when the rolling of the vessel prevents the lighting 
of the galley fire and the preparation of coffee or tea, when 
they have been more than thirty days at sea and begin to man- 
ifest the consequent ill-effects of the salt ration, or when they 
are subjected to intense mental or physical effort, as in time of 
shipwreck, fire, or action. There is no doubt that under such 
circumstances tobacco-chewers and smokers find a mental and 
physical sustenance for which other men instinctively and pain- 
fully crave; and we need not hesitate to refuse to join the pseudo- 
moral crusade which would deprive the sailor of the solace and ' 
support of his pipe and quid, when so learned a therapeutist 
as Pereira declares, "I am not acquainted with any well-ascer- 
tained ill-effects resulting from the habitual practice of smoking." 
A similar observation is made by Dr. Christisou ; and Ham 
niond, whose carefully conducted experiments upon himself 
have conclusively establisbed the physiological effects of these 
agents, states, " I have no hesitation in expressing my opinion 
that, in the great majority of cases, the moderate use of alcohol 
and tobacco is calculated to exert a beneficial effect upon the 
organism. This use, like that of every other good thing which 
we have, must be guided by wisdom. To transgress the laws 
of our being in the employment of these substances leads just 
as surely to punishment as the violation of any other sanitary 
or physiological law. Like everything else capable of producing 
great good, alcohol can also cause great harm. Our object should 
be to secure the one and provide against the other. 1 am decid- 
edly of the opinion that tobacco is beneficial to those who, like 
soldiers, have a great deal of mental and bodily fatigue to 
undergo. But these remarks apply only to the moderate use. 
When employed to excess, there is no doubt that it predisposes 
to neuralgia, vertigo, indigestion, and other affections of the 
nervous, circulatory, and digestive organs." For those who are 
debarred from using tobacco and alcohol, an extra issue of cof- 
fee on turning out, and occasionally during the night-watches, 
will supply the demand of the system when it is improperly or 
insufficiently nourished. 

Though comparatively little fault can be found with the com- 
ponent parts of the ration, the same is not true of the arrange- 
ment of meals. The usual hours for breakfast is 8 o'clock; for 



MEDICAL AND SURGICAL ESSAYS. ;")!) 

dinner, at noon ; and for supper, 4 o'clock. By this system men 
eat three times within eight hours and fast all the rest of the 
day. The objections to it are evident. Economy of fuel is no 
excuse for a practice that is so contrary to the simplest teach- 
ings of hygiene and common sense. It is far more easy to pro- 
vide a larger quantity of wood and coal before setting out than 
to teach a man's stomach to regulate its functions according to 
the arbitrary dictum of his "superior officer." After the sup- 
per, the sailor gets nothing to eat for sixteen hours, although 
his most arduous duties frequently occur within that period, 
and although the craving for food is manifest even in officers, 
who eat their last meal so much later, and who universally re- 
quire the caterers of their messes to provide them a lunch before 
going on deck during the night and morning watches. At sea 
the labors of the night are probably more frequently laborious 
than those of the day; while in port the vessel may have been 
brought to anchor or gotten under way, and in the morning ham- 
mocks have to be scrubbed, clothes washed, and decks holy- 
stoned ; and all this witli an empty stomach. In hot climates, 
both men and officers always feel listless and indisposed for 
exertion in the morning, when a slight repast would give them 
the energy to perform their duties properly. Hammond ad- 
vises that ''soldiers should always be ted before they are sent 
to drills, parades, or other labor," and Macleod declares that 
he has little doubt that, if the precaution had been taken to 
supply the troops in the Crimea every morning with hot coffee, 
much of their mortality might have been avoided. I therefore 
recommend that every man may be served a cup of coffee and 
piece of bread immediately after turning out, and that break- 
fast be eaten at 7 o'clock, dinner at noon, and supper at o'clock, 
the dinner hour of many cabin and ward-room messes. In port 
all hands turn out at daylight and should then have their broad 
and hot coffee; at sea, the morning watch comes on deck at 4 
o'clock and should be allowed coffee as soon as it can be made. 
The other watch is called with "all hands" at 7 o'clock, the hour 
I propose for breakfast. To give them time to lash aud stow 
their hammocks, wash, and dress before breakfast, they should 
be called at ten or fifteen minutes before 7, in which quarter of 
an hour they will be able to do all they are required. The range 
should be given up to the berth-deck cooks to make scouses until 
fifteen minutes before 7 o'clock, which is early enough for the 
officers' cooks to begin their breakfast. In bad weather, unless 



60 MEDICAL AND SURGICAL ESSAYS. 

the ship roll too heavily for safety, or when the work is very 
arduous, fire should be kept in the galley and hot coffee served 
out to the middle and morning watches. It is getting to be a 
custom to light the galley-tire in the morning watcb, to make 
the officer of the deck his cup of coffee, when the ship's and 
officers' cooks take advantage of the opportunity to prepare 
coffee, which they retail to such men as are able or willing to 
pay their charges; but this is done surreptitiously, at an ex- 
pense to the men which they cannot always afford, and in the 
cases of the officers' cooks at the expense of the officers, whose 
private stores supply the materials used. To prevent this fraud 
and to enable every one of the crew to be benefited by the pro- 
cedure, the Government should make it a regular daily issue; 
or, if objection is urged to the increased cost of the ration, such 
a change should be determined upon by the paymaster as will 
purchase the coffee required. I have known instances of ship's 
cooks who have amassed several thousand dollars during a 
cruise, by irregular sales, principally of coffee. 

An improvement should be made in the furniture of the 
messes. Everything is repulsive about the sailor's mess-cloth, 
where each man is using his fingers and the jack-knife with 
which he may have been scraping masts or cleaning tar-buckets. 
A few, cheap, strong knives and forks, block-tin plates, cups, 
&c., might be included among the paymaster's small stores. 
The British sailor receives his mess utensils from the govern- 
ment gratis. In large ships, tables and camp-stools are pro- 
vided for the men, and might appropriately be made a part of 
the outfit -of every vessel, care being taken to stow them, when 
not -in use, so as not to encroach on the air-space of the berth- 
deck. 

The medical officers should frequently visit the messes and 
inquire into everything relating to their subsistence. This duty 
is especially enjoined upon the surgeon by paragraph 534 of 
the Regulations for the Government of the United States Navy 
for 1870, and which, so far as the medical officer is concerned 
in his character as physician, is the most important in the book. 
Hence I quote it, and urge upon the young assistant surgeon 
the necessity of pondering seriously upon the grave responsi- 
bilities it devolves upon him: 

He. (the surgeon) shall inspect, the provisions for the crew, and report to 
the commanding officer when he may discover any that are unsound. Ho 
will also cause the purity of the water to be tested before it is received into 



MEDICAL, AND SURGICAL ESSAYS. Gl 

the tanks, and he will make known to the commanding officer any want of 
cave or cleanliness in the preparation of food for the crew, or any instance 
of personal neglect with regard to it, of which he may be cognizant. He 
will also make known to the commanding officer everything which may 
come to his knowledge as conducive to, or as militating against, the general 
health and comfort of the ship's company. 

Although these sanitary functions are manifestly among the 
legitimate duties of the physician, the Navy Department, in 
these instructions, very properly directs particular attention to 
them, and every medical officer should beheld strictly account- 
able for the consequences of any violation of a proper hygiene 
which he may have neglected to investigate and report. 

POTABLE WATER. 

Physiologists estimate that the daily loss of fluid by cuta- 
neous and pulmonary exhalation is from one and three-quarters 
to five pounds; that of the thirty or forty ounces of urine 
excreted only two to seven per cent, are solid, and that seventy- 
five per cent, of the faecal discharge of the twenty-four hours, 
which averages from four to six ounces, is water, a total loss of 
fluid every day of from three and a half to seven and a half 
pounds. The customary allowance of water on ship-board is 
one gallon a day for each person, of which half is given to the 
ship's cook for the coppers and the balance put into the scuttle- 
butt for drinking. This allowance is sufficient under ordinary 
circumstances, but during hot weather the water is all drank 
np in the forenoon, and the landsmen and boys, who have been 
less employed than the rest of the crew, usually drink a dispro- 
portionate share. While, therefore, the issue of water should 
never be less than a gallon a day in temperate latitudes, this 
amount should be largely increased whenever the crew are 
exposed to unusual fatigue or to prolonged heat. The listless, 
careless way in which the men go through their exercises in 
tropical climates, is as much due to the stint of water as to the 
direct depressing effect of heat. According to Parkes " the 
supply of water becomes a matter of the most urgent necessity 
when men are. undergoing great muscular efforts, as it is abso- 
lutely impossible that these efforts can be continued without it. 
If we reflect on the immense loss of water by the skin and 
lungs which attends any great physical exertion, we shall see 
that to make up for this loss is imperative ; and it is very im- 
portant that this loss should be made up continually by small 



02 MEDICAL AND SURGICAL ESSAYS. 

quantities of water being constantly taken, and not by any 
large amount at any one time." 

An article which enters so intimately into the composition of 
the animal economy, which permeates every tissue and forms 
the basis of the various circulating media, which has so much 
to do with the reparation of the body and the normal perform- 
ance of its functions, should be as free as possible from nocuous 
qualities. The terrible mortality of the old-time vessels was 
due as much to the excess of saline and the presence of putres- 
cent matters in their water as to the neglect of any other of 
the measures which hygiene demonstrates to be indispensable 
to health. To this effect Pereira quotes a report of the Brit- 
ish secretary of state for the home department: "The bene- 
ficial effects derived from care as to the qualities of water is 
now proved in the navy, where fataj dysentery formerly pre- 
vailed to an immense extent in consequence of the impure and 
putrid state of the supplies." Though a certain amount of 
saline constituents is essential to good potable water, a very 
slight excess of any one salt will occasion grave disturbance of 
health. Carpenter relates an instance where serious detri- 
ment to the health of a neighborhood was occasioned by using 
the water of a well containing only five grains of saline matters 
to the pint. According to Ohristison one two-thousandth of 
its weight of saline ingredients (thirty-five grains in the impe- 
rial gallon) renders water unfit for domestic purposes. French 
writers have incontestably shown that the intestinal disorders, 
which w r ere common among the inmates of certain hospitals 
and prisons of Paris, were directly traceable to the use of well- 
waters containing lime and magnesia sulphates. Parkes refers 
to the prevalence of diarrhoea on the cape frontier stations, 
under his own observation, from the use of brackish water ; 
the deleterious effects of our western river waters on non-resi- 
dents are widely known ; and there is no doubt that malignant 
cholera is principally, if not exclusively, as*Dr. Snow thought, 
transmitted through the medium of drinking-water. 

So much, then, depending on the character of the water, it 
should never be received on board ship for drinking and culi- 
nary purposes until it has been submitted to the medical officers, 
faithfully and carefully examined by them, and pronounced 
potable. Notwithstanding the very serious interests involved, 
this subject has not received a tittle of the attention it 
deserves. Most medical officers, when notified that water is 



MEDICAL AND SURGICAL ESSAYS. 63 

about to be taken on board, direct their apothecaries to add a 
piece of crystallized nitrate of silver to a tumblerful of the 
water, and if the precipitate produced is not a positive cloud 
tilling' the tumbler, and the taste not markedly brackish, .con- 
sent to pass it. Frequently, this is the extent of the chemical 
means they have at hand, but the careless manner in which 
even this test is applied renders it practically useless. The 
taste of water, on which so much reliance is ordinarily placed, 
is a very unsafe guide, since, according to Parkes, " organic 
matter, when dissolved, is often quite tasteless; 55 grains of 
carbonate of soda and 70 of chloride of sodium per gallon are 
imperceptible ; 10 grains of carbonate of lime give no taste ; 
25 grains of sulphate of lime very little ; " yet, a potable water, 
according to the same authority, should never contain more 
than 20 grains of carbonate or 10 of chloride of sodium, 16 of 
carbonate or 3 of sulphate of lime, or 3 of the carbonate and 
sulphate of magnesia. 

Water to be potable does not require to be chemically pure. 
The stomach instinctively loathes water freshly distilled, rain- 
water recently fallen, and the water formed by the melting of 
ice and snow. The eminent hygienist G-uerard describes good 
potable water as " limpid, temperate in winter, cool in sum- 
mer, inodorous, of an agreeable taste. It should dissolve soap 
without forming clots ; be fit for cooking dried beans ; hold in 
solution a proper quantity of air, carbonic acid gas, and min- 
eral substances : these last not exceeding 0.5 gram to the 
liter, (35 grains per gallon.) Finally, it should be free from 
organic matters." 

The river waters, from which our principal naval stations 
are supplied, contain a far less proportion of saline constitu- 
ents than this. According to Professor Barker " the purest 
water supplied to any city in this country is that from Lake 
Cochituate, which supplies Boston, which contains but 3.11 
grains (solid matter) in one gallon. The Schuylkill water, 
(Philadelphia,) contains 3.50 grains ; Ridgewood, (Brooklyn,) 
3.92; the Croton, (New York,) 4.78 ; Lake Michigan, (Chicago,) 
6.68 ; the water which supplies Albany 10.78." European rivers 
are seldom so pure. The Loire, Garonne, and Danube average 
about 10 grains; the Rhine 12; the Rhone 13; the Seine, Scheldt, 
and Thames range from 16 to 30. Fonssagrives restricts the pro- 
portion of salts which a potable water should contain to from 
0.10 to 0.20 gram per liter, (7 to 14 grains per gallon;) " beyond 



64 MEDICAL AND SURGICAL, ESSAYS. 

this, the water is hard, indigestible, and unfit for cooking veg- 
etables." Ohristison considers a water to be hard which con- 
tains one four-thousandth part, or 17J grains of saline matter 
to the gallon, and says that that which contains not more than 
14 grains will lather with soap, and may therefore be used for 
washing. The absolute amount of saline substances is, how- 
ever, of less practical importance than the quantity of each 
particular salt, since a small amount of calcium sulphate will 
render a water harder than twice or thrice as much of alkaline 
carbonates, aud if organic matters are also present the reduction 
of the sulphate will render the water offensive from the dis- 
engagement of hydrogen sulphide. 

The saline ingredients of ordinary river water are principally 
the chlorides, sulphates, carbonates, aud phosphates of sodium 
aud calcium, the chloride, bromide, carbonate and sulphate of 
magnesium, the chloride and sulphate of potassium, a little 
silica, oxide of iron, and occasionally other metallic salts. Of 
these, sodium chloride and calcium carbonate and sulphate form 
the largest proportion. 

The medical officer of a man-of-war has no need to attempt a 
complete analysis of water, for which, indeed, he will have neither 
time, place, nor appliances in conducting his examination as to 
its fitness for drinking and culinary purposes, but he should 
never give his consent to the reception on board ship of any 
water which does not posess the physical properties enumer- 
ated by Guerard, which curdles a standard solution of soap, 
which decolorizes a standard dilute solution of potassium per- 
manganate, and which gives more than a faint white precipi- 
tate, insoluble in nitrate acid with silver nitrate, barium 
chloride aud ammonium oxalate. Most common waters have an 
alkaline reaction from calcium carbonate, held in solution by 
carbon di-oxide, but this gas is expelled by ebullition, the car- 
bonate is precipitated, and forms tbe ordinary lining crust of 
tea-kettles. " Six grains per gallon of a lime salt give a turbid- 
ity with oxalate of ammonia ; sixteen grains a considerable 
precipitate ; thirty grains' a very large precipitate." " As only 
two grains per gallon of carbonate of lime can remain in solu- 
tion after boiling, a large precipitate on the subsequent addi- 
tion of another portion of the oxalate will show that the sul- 
phate or chloride of lime is present." "Four grains per gallon 
of chloride of sodium give a turbidity with an acidulated solu- 
tion of nitrate of silver ; ten grains a slight precipitate ; twenty 



MEDICAL AND SURGICAL ESSAYS. 65 

pains a considerable precipitate." " Sulphates to the amount 
of one or even one and a-half grains per gallon, give no pre- 
cipitate with chloride of barium ; at first, or on standing, three 
grains give a haze, and after a time a slight precipitate; above 
this amount the precipitate is pretty well marked." — (Parkes.) 

Fortunately, there is now very little difficulty in obtaining a 
sufficieut supply of excellent potable water at the principal 
resorts of our naval Vessels, to obviate the necessity of water- 
ing ship with impure water — a necessity, which in the case of 
steamers, of course, never can exist. In some tropical sea-ports, 
as Anjer, where the water is necessarily largely impregnated 
with vegetable matter, filtered water may be obtained at a small 
charge, and I was once witness of the lamentable consequences 
of a commanding officer's refusal, through a mistaken spirit of 
economy, to incur this expeuse. Parkes quotes as a curious 
fact from Davis, in reference to the West Indies, that ships' 
crews, when ordered to Tortola, were " invariably seized with 
fluxes," which were caused by the water. But the inhabitants, 
who used tank (rain) water, were free ; and so well known was 
this, that when any resident at Tortola was invited to dinner on 
board a man-of-war, it was no unusual thing for him to carry 
his drinking water with him." 

Should it become necessary to obtain water from unknown 
places, the medical officer should always examine its source, 
nieaus of transit, preservation, &c. It is manifestly improper 
to fill up from stagnant pools, shaded and sluggish streams, 
marshes, mineral springs, &c, nor should any springs or wells 
ever be completely exhausted. During the late war I have 
known whole tanks rendered unfit for drinking by the final 
addition of a cask obtained by the exhaustion of a spring. 
Bain water, though largely aerated, it is insipid from deficiency 
of salts, while melted ice and snow lack both the necessary 
gaseous and mineral ingredients, and require the same treat- 
ment as distilled water to be potable. Captain Cook's attempt 
to water ship from an iceberg resulted disastrously to the health 
of his crew. Snow itself does not assuage thirst, and absorbs 
ammonia in such quantities that its ingestion is often attended 
with dangerous and, in several cases of children, fatal conse- 
quences. 

Boat expeditions or exploring parties on laud may sometimes 
be compelled to use only such water as they can get, when the 
preferable mode of purifying it will be by filtration through 
5 M 



66 MEDICAL AND SURGICAL ESSAYS. 

sand and charcoal. Water containing principally organic mat- 
ters in solution is rapidly purified by means of potassium per- 
manganate. Calcareous water, containing the carbonate, may 
be improved by the addition of pure lime water, which combines 
with the solvent, (C0 2 ,) and precipitates it as carbonate, along 
with the rest of that salt which it had held in solution. Water 
containing calcium sulphate in excess is more objectionable than 
that holding an excess of carbonate, for though the addition of 
bicarbonate of soda will likewise throw down the lime carbon- 
ate, the sodium sulphate left in solution gives the water a dis- 
agreeable taste and unpleasant laxative qualities. The objec- 
tion to the popular French plan of purifying turbid water, 
entitled u Alunage de l'Eau," which simply consisted in the 
addition of a small quantity of alum, was that, while clarifying 
the water, it merely converted the lime carbonate into sulphate, 
which remained in solution and rendered the water worse than 
before. Youatt says that the horse, " through instinct or experi- 
ence, will leave the most transparent and pure (?) water of the 
well for a river, although the water may be turbid, and even for 
the muddiest pool." 

A common source of impurity in water brought on board 
ship is the leakage of the water-boat, casks, or tanks, in which 
it is conveyed from on shore. These are frequently old, are 
seldom or imperfectly cleansed, not properly calked and lined,, 
or are open to salt spray or to the swashing of salt water into 
the pump-well. A pint of sea water contains from three hun- 
dred and six to three hundred and fifteen grains of saline sub- 
stances, while less than two grains in that quantity are the 
most that can be drank any length of time with entire impu- 
nity, consequently a single gallon of sea water will render unfit 
for drinking more than a hundred of otherwise pure water. 
Hence a sample of water should be examined out of every tank, 
and several, if it remains alongside of the ship any length of 
time. Where the young medical officer is in doubt whether the 
water examined falls far enough below the standard to be 
rejected, let him always decide against and decline to approve it. 

The greater part of the water used on board steamers is dis- 
tilled from the sea, and the attention of engineers and construct- 
ors has been directed to the production of an apparatus which 
shall accomplish this in the most satisfactory manner. The 
disagreeable empyreumatic odor and flavor usually attending 
water from this source, its chemical purity and consequent 



MEDICAL AND SURGICAL ESSAYS. 67 

insipidity are the principal faults which have to be remedied. 
The first depending on defective process of distillation, has been 
gotten rid of as this has improved. Perroy's apparatus, as 
modified by Bourel-Ronciere in use in the French naval 
service, is probably the best yet devised ; the steam generated 
by the boilers of the engine being condensed by the water of 
the sea surrounding the vessel, in the midst of a current of air, 
by which it is aerated and deprived of empyreuma by filtration 
through granular animal charcoal. This filter consists of a 
tinned sheet-iron bos, divided internally into four compart- 
ments, separated by vertical partitions, pierced with alternate 
holes, so that the water produced traverses successively the 
entire mass of charcoal contained in the four compartments, 
and becomes immediately potable as it leaves the apparatus. 
The condenser is a simple tinned copper tube, placed on the 
outside of the keel, about a meter below the water-line, secured 
firmly to the vessel, and covered up so as to prevent its injury 
by the grounding of the vessel, but not to hinder her steerage- 
way. After running a certain distance outside, it enters the 
ship's side and discharges the fresh water obtained by the con- 
densation of the steam under the cooling influence of the sea- 
water. Corks at the two extremities regulate the admission of 
steam and the discharge of water. A minute analysis of the 
waters obtained on board La Circe, where Bourel Eonciere per- 
formed his experiments with distillating apparatus, was made 
at the nnval medical school at Toulon, by M. Fontaine, premier 
pharmacien en chef, and demonstrated that at the first working 
of the apparatus they contained sodium chloride in sensible 
quantity, a few sulphates and traces of organic matters ; but 
Bourel-Ronciere claims that as the apparatus is worked the 
water becomes purer, and the quantity of saline matters is much 
diminished, and, after having Perry's filter, it is sufficiently 
aerated to be healthy and salubrious. '' The problem of the dis- 
tillation of sea-water," adds A. Tardieu, from whom I have 
obtained these facts, "may thus be considered as practically 
settled." Fonssagrives proposes to supply the deficiency of 
saline matter in distilled water by the addition to every hundred 
gallons of a mixture containing about half a drachm of sodium 
chloride, a scruple of sodium sulphate, six drachms of calcium 
carbonate, a drachm and a half of sodium carbonate, and two 
scruples of magnesium carbonate, the aggregate amount of 
salification amounting to 5.4 grains per gallon. Besides the 



68 MEDICAL AND SURGICAL ESSAYS. 

mechanical means for aerating the water, if the tank is only filled 
to the extent of two-thirds its capacity, the motion of the vessel 
will agitate it sufficiently to cause it to dissolve a larger propor- 
tion of the gaseous constituents of the atmosphere. A crystal 
of green ferrous sulphate will not produce the characteristic 
ocherish discoloration unless air is present. 

Not infrequently water, unobjectionable when brought off or 
distilled on board, is seriously impaired after it has been placed 
in the tanks. This is the case when the latter have been white- 
washed inside, a practice that cannot be too severely condemned. 
I sailed from Boston, in the autumn of 1858, on board the 
Dolphin, of which the tanks had been treated in this way, and, 
with every other officer and man, I was tormented with burning 
thirst, dryness of mouth and fauces, nauseous taste, epigastric 
heat, &c, until we arrived at Buenos Ayres. The tea, coffee, 
and soups were also spoiled. Still another cause of the dete- 
rioration of water on board ship is overlooked. It is a very 
general custom to fill the tanks as soon as they have been emp- 
tied, with sea-water, either to preserve the trim of the vessel or 
to prevent capsizing, though on board steamers provided with 
distilling apparatus there can be no possible pretext for using 
salt-water for this purpose. With the greatest care it is diffi- 
cult to remove the effects of this procedure, and the destruction 
of the brackishness of the water by the chemical action of the 
iron is inconsiderable ; but usually, the only cleansing attempted 
is to pump out the salt-water, wash the tanks with a few gallons 
of fresh, and then replenish them. The tanks of some small 
vessels will not admit a boy, and frequently the beams of the 
berth-deck partly cover the man-hole openings, so that it is not 
possible to reach but a small portion of their surface. The sub- 
stitution of iron tanks for casks is one of the greatest improve- 
ments hygiene has effected in modern naval establishments, and 
its satisfactory results should secure attention to other sugges- 
tions emanating from this department of the medical profession. 
Tanks, however, require considerable care. They should always 
be thoroughly cleansed when emptied, scraped, well rinsed with 
fresh, preferably distilled water, and waxed before they are 
refilled. Galvanizing the inside of the tanks is open to the objec- 
tion that it will add another foreign substance to the water in 
the -shape of salt of zinc. The scuttle-butt ought also to be 
of iron; it should be cleansed and waxed every month, and 
provided with a filtering diaphragm of sand and charcoal, which 



MEDICAL AND SURGICAL ESSAYS. 69 

must be occasionally removed and renewed. I have known 
vessels on which the scuttle-butt was not disturbed during the 
whole cruise. 

Instead of the ordinary mess-pot holding nearly a quart, such 
as is used for tea and coffee, which is filled and emptied at a 
draught, and oftenest by the landmen, writers, boys, &c, who 
require it least, a small tin drinkiug-cup, of the capacity of a 
gill, should be attached by a chain to the faucet of the scuttle- 
butt, and allowed to be filled but once at each drinking. This 
quantity is as much as should be swallowed at any oue time, 
and will enable the man to get from ten to fifteen full draughts 
a day. The sentry on post should be instructed to prevent any 
particular set of men from using an undue share. The whole 
daily allowance should not be pumped, into the scuttle-butt at 
one time, but at intervals, during the day ; thus, if the entire 
daily amount is one hundred gallons, let fifty be introduced at 
9 a. m., thirty at 2 p. m., and .the balance at 8 p. m. The tea 
and coffee will supply its place at intermediate times. The 
addition of oat-meal to water is customary with engineers and 
firemen, a smaller quantity thus more effectually relieving thirst. 
At general quarters, uot only the scuttle-butt should be filled, 
but the mess-kettles of the berth-deck cooks, which should be 
convenient to be passed on deck by the powder division. Similar 
provision for an extra supply of water should be made whenever 
any other protracted or exhausting labor is undertaken. 

SLEEP. 

The graphic descriptions by reporters of the filth of some of 
the unclean and degraded poor of our great cities would find 
a parallel on the berth-decks of many of our men-of-war at 
night. It is a place that few officers but those of the medical 
corps ever visit at that time ; and the close bulkheads of the 
comparatively well-ventilated ward-room exclude the foul and 
stifling odors of the adjoining apartment. It is impossible to 
remain many minutes among the hammocks without experi- 
encing a sensation of suffocation and nausea ; indeed it is only 
necessary to lean over the main hatch, toward the close of the 
first watch, to recognize the heavy mawkish odor that arises 
and betokens the overcrowding of human beings. That these 
beings are injuriously affected by what appeals so forcibly to 
our senses and excites disgust, does not admit of question. I 
have referred incidentally to this subject of overcrowding when 



70 MEDICAL AND SURGICAL ESSAYS. 

speaking of ventilation, and have shown the evil of the system 
which fills vessels with more men than they can berth, even 
with hammocks swinging so closely together that the move- 
ments of one man disturbs all those among whom he is wedged. 
The berthing capacity of every vessel should be determined by 
a commission of officers, wholly or in part of the medical corps, 
and should be the guide to the regulation of the armament, 
rather than that a certain number of guns should be put on 
board and a certain allowance of human muscle, like that of 
tackle and brcechings, be subordinate thereto. The ship carry- 
ing a small battery, manned by a hundred athletic healthy 
men, will be far more efficient than one bristling with cannon 
and encumbered with twenty or thirty daily sick, and twice as 
many more enfeebled convalescents. 

At sea only one watch sleep below ; but all the advantages 
derived from the increased breathing-space thus afforded are 
counterbalanced by a horribly disgusting and abominable prac- 
tice which is enforced on board many — probably a majority 
of vessels — of compelling the watch that come from deck to 
turn into the hammocks of the men who relieve them. Per- 
haps an officer, who never visits the berth-deck at night, and 
whose own bunk is clean and dry, can complacently issue such 
an order and reply to any remonstrance made that '' men must 
not expect to get all the comforts of life with eighteen dollars 
a month ; " but the medical officer, who is ever mindful of the 
solemn responsibilities of his profession, will denounce this 
practice with every expression of abhorrence. Fancy the loath- 
ing with which a clean man must regard the compulsion to 
sleep in the bed of a fellow of unclean habits, diseased with 
venereal, affected with cutaneous eruptions, or vermin, whose 
skin is naturally offensive, or whose blankets are always wet 
from incontinence of urine, or spermatorrhoea, or the equal repug- 
nance he must experience at having his own clean bedding 
soiled by such a fellow. There is never the shadow of necessity 
to excuse this detestable custom. In pleasant weather each 
watch should be compelled to "lash and carry." The unoccu- 
pied hammocks should not be left below, except when they 
would get wet by being stowed in the nettings, and then they 
should be allowed to remain on their appropriate hooks, or 
piled up in some convenient place. 

I have already insisted that the watch coming below should 
remove their wet clothes before turning in, and that if thev 



MEDICAL AND SURGICAL ESSAYS. 71 

have exhausted the three changes which a proper outfit would 
allow, that they should remove their outer shirts and panta- 
loons, and hang them on their hammock-hooks. In this way 
the contents of the hammock may be kept dry and clean. No 
wet articles should ever be stowed either in the hammocks or 
hammock-nettings. 

All bedding should be exposed in the rigging to the air and 
sun at least once a week, if the weather will permit. The 
blankets and mattress should be well shaken, and the latter 
should be repicked once or twice during the cruise. Hennen, 
writing on military hygiene, advises the daily exposure of sol- 
diers' bedding to the sun. I have known vessels in which bed- 
ding had not been opened for this purpose for several months, 
where there was no care taken to prevent men turning in wet, 
and where the gonorrhoeal, the syphilitic, the eczematous, those 
incontinent of urine, and those affected with diarrhoea, slept 
alternately with the clean in each other's bedding. Opportuni- 
ties should be improved of compelling the men to wash their 
blankets, one or both at a time, and their mattress-covers, in 
fresh water. These articles become quickly soiled with blue 
dye-stuff during the first weeks that new flannel is worn. 
Although we have often imitated or adhered to the customs of 
the British service with questionable profit, I cannot refrain 
from expressing a hope that our Government will adopt the 
course of the lords commissioners of the British admiralty, who, 
" being desirous that the seaman, on entering, as far as practi- 
cable, may be freed from the necessity of incurring debt, are 
pleased to direct that all men and boys, on first joining one of 
Her Majesty's ships, shall be supplied with a bed, blanket, and 
bed-cover free of charge." As they are the property of the 
Crown, aud have to be returned, paymasters are interested in 
having them kept in good order ; and the care taken to this 
end thus indirectly assists to a result which, with only hygiene 
recommending it, would never have been attained. 

The greasy bla"ck hammock-lashing is a relic of old-time 
customs, which should go the way of others of its kind. The 
neat white " tie-tie," or stop, does not soil the hammock, lessens 
the task of cleaning, and does not break the mattress. Ham- 
mocks are adapted for them with very little trouble, aud the 
bedding may be more expeditiously tied up and taken on deck 
than when a lashing has to be adjusted. 

In pleasant weather the greater part of the watch on deck 



72 MEDICAL AND SURGICAL ESSAYS. 

sleep on tbe spar-deck, wherever they cau find places. Unless 
the decks are perfectly dry, this should be interdicted. Care 
should also be taken that the men never lie down where they 
will be exposed to dew or to currents of air through air-ports 
and scupper-holes. The great number of aural diseases which 
appear on the medical returns of the service are occasioned in 
this way. 

The necessary interruptions of the sleep of the sailor affect 
his health, but many of the needless discomforts aud sources of 
disease may be abolished with great benefit to the service, as 
when " all bands " are called during the night in consequence 
of clumsily executed maneuvers or to punish a few lazy and 
inefficient men. 

EXERCISE. 

Among other " non-naturals " which require attention from 
the naval hygienist, is want of exercise. The sailor's occupa- 
tion furnishes occasion enough for physical development, but 
there is a numerous class of persons on board vessels of war, 
intrusted with special duties, who do not share the open air 
labors of the mariner. These are the apothecaries, nurses, 
yeomen, schoolmasters, writers, masters-at-arms, ship's cor- 
porals, captains of the hold, permanent berth-deck cooks, offi- 
cers' stewards, cooks, and servants, musicians, printers, painters, 
tailors, &c. They are recognizable at the weekly muster on 
Sunday by their pallid countenances, faltering gait, and untidy, 
slovenly dress. They are unclean and indolent as a class, are 
scantily provided with clothing, and form a large proportion of 
the sick. The dark and lonely corners where they abide are 
the favorite haunts of those guilty of those secret practices 
that are so rife on board some men-of-war. Many yeomen pass 
the entire day in the store-room, which sometimes is without a 
scuttle overhead, or even an auger-hole in the door, where they 
breathe a confined and stagnant atmosphere, still further im- 
poverished and heated by two or three constantly burning oil- 
lamps or candles. The captain of the hold whiles away his 
leisure hours in the main hold, where he keeps his ditty-box, 
and the regular cooks seldom quit the vicinity of the galley 
before night, when the fires are extinguished. The system of 
steady berth-deck cooks reduces eight, ten, or more of the crew, 
according to the number of messes, to this etiolated condition, 
and it ought, therefore, to be discountenanced. Every man, 



MEDICAL, AND SURGICAL ESSAYS. 73 

except the higher petty officers, should be required to perform 
the duty of mess-cook or caterer (for the former term is a mis- 
nomer) in rotation, changes being made at least monthly, and 
while attending to this duty he should not be excused from 
the regular exercises of his division or station, an alternate 
performing his mess work. All others whose special duties 
confine them below should be compelled to pass a certain por- 
tion of each day, during the hours of daylight, in the open air. 
They should either be attached as supernumeraries to the regu- 
lar divisions, or be exercised together at the great guns, at 
small-arms, single sticks, rowing, or going aloft. No conflict 
of departments need occur in this if officers of the various 
corps are actuated by proper feelings toward each other and 
toward the service. It is not presumed that the surgeon will 
be deprived of the services of the apothecary or nurses when- 
ever these may be required ; nor that the paymaster will have 
to subordinate the business of his department to his writer's 
exercise ; nor that the captain of the hold will have to neglect 
his work to play at topman or loader and sponger ; nor that 
the cabin and ward-room dinners shall become cold or go un- 
cooked, and Mr. 's boy lay down his razor and leave the 

lathered chin unshaven whenever small-arm men are called away. 
The special duties for which these individuals are respectively 
employed must be attended to in preference to everything else, 
but then the officer who directs or controls this special duty 
should not throw obstacles in the way of exercise, however 
distasteful it may be to the subordinate, by requiring untimely 
and unnecessary services, but, prompted by a desire to promote 
the general interests, should cheerfully co-operate to this end. 

CLIMATIC INFLUENCES. 

The exposures incident to the sailor's life are supposed to 
fit him to endure with impunity extremes of temperature or any 
inclemency of season. It is a popular belief that no amount of 
soaking in salt water will give one cold, though an old salt 
who is not also a chronic rheumatic is a rarity. The careless- 
ness consequent upon these ideas has its result, as shown by 
statistics, in shortening the seaman's life. However slow to 
contract disease or to be affected by ordinary vicissitudes, 
the unnatural circumstances under which he lives give an 
unfavorable character to all his complaints, and maladies of 
equal severity in their incipiency are therefore more fatal at 



74 MEDICAL AND SURGICAL ESSAYS. 

sea than on shore. The most potent causes of disease in the sea- 
man are not accidental exposure to cold, occasional getting wet, 
gluttonous eating of unripe fruit or indulgence in unrestrained 
debauch ; but they are those which gradually undermine his 
constitution, and result from the neglect to adapt his diet, 
dress, and duty to the hygienic requirements of the climate in 
which he lives. Sailors are made up of the same tissues as 
princes and gentle-folk, and though habit may modify the 
effects of natural causes, it cannot altogether nullify them. It 
is now very generally believed that certain races were created 
for certain localities, if not created in or by them. Acclima- 
tion is no longer regarded as a fact, for such excellent 
authorities as Johnson and Martin assert that " residence 
confers only certain immunities and privileges, and that so far 
only is there truth in the doctrine of acclimation." Even this 
tolerance, created by a residence of a year or two in a foreign 
climate, is at the expense of constitutional vigor. Darwin 
declares that " it is certain that with sailors their manner of 
life delays growth," as shown by the great difference between 
the statures of soldiers and sailors. The Government has, 
therefore, acted wisely in abandoning the practice of long 
cruises. Three years are the most that can be safely passed 
on any one station notably unlike the native climate, since, 
with every attention to hygienic precautions, there will be 
such a general loss of constitutional strength among the crew 
that they will become ill from slight causes, and such perma- 
nent organic injury will be received by many officers as well 
as men as to unfit them for future energetic duty. A British 
steam sloop-of-war, cruising on the Caribbean coast of Central 
America, in 1859, had had nearly three complete crews during 
the five years she had been in commission, and her commander 
told me that those officers and men who had remained from 
the beginning were becoming stultified in mind. A liberal 
Government like our own has no excuse in the saving of 
expense, if there really be any such, to commit the inhumanity 
of compelling its men and officers to remain so long from their 
families and country. The best American merchant sailors 
will not enter the service while they are kept beyond two years, 
and officers are not made better citizens and members of 
society if they are exiled so long that the recollection of home 
becomes a dream of the past. 

Of extreme climates, the cold are more readily borne by our 



MEDICAL AND SURGICAL ESSAYS. 75 

Crews than the hot, being more like the rigorous winters to 
which they have been accustomed. The effects of cold, more- 
over, can be better guarded against, not only by proper cloth- 
ing but by the observance of a strict hygiene, especially in the 
matter of diet and ventilation. Eaw fat meat seems to be the 
appropriate food, though the scurvy of the frigid zone is not 
merely the result of improper alimentation, but of neglect of 
all the laws of health. Instinct and appetite guide to what 
should be eaten, but foul air and filth are submitted to despite 
the frightful havoc they assist in causing. What an intelligent 
observance of sanitary laws will accomplish under the most 
unfavorable circumstances was markedly demonstrated in the 
Arctic expedition commanded and directed by Dr. Hayes. 

The combined influence of protracted exposure to the elevated 
temperature, moisture and organic growth and decay, which 
characterize tropical climates, in connection with an almost 
universally neglected hygiene, occasion serious functional dis- 
turbances, which lay the foundation of irreparable structural 
lesions, the peculiarities of which are, of course, familiar to the 
educated physican. The lungs and kidneys are brought into 
fuller activity under a low temperature, while the liver and 
skin are excited to greater functional effort under a high one. 
Zymotic fevers, diarrhoea, and dysentery are the most intract- 
able of the complaints of the torrid zone, but they are so fully 
described in the current medical literature as to render un- 
necessary any special reference to their technical history. 
When the interests of the service require the visit to prolonged 
sojourn in any unhealthy place, the advice and judgment of 
the medical officer must be relied on to provide for the special 
necessities of the time. The prophylactic administration of 
the salts of quinine, the diminution of the ration of meat, and 
increase of the proportion of vegetables, the purchase of fruits, 
the issue of spirits or its substitution by wine, are among those 
measures that should be left to his individual discretion. I 
have only to indicate a few precautious of universal applica- 
bility. 

Although the permanent squadron on the west coast of Africa 
has been discontinued, vessels of the European fleet occasion- 
ally visit there, and the sanitary regulations of Secretary Pres- 
ton, issued January 23, 1850, are still in operation, (vide para- 
graph 832, Regulations for the Navy, 1870,) and should be 
enforced on all other stations where similar climatic conditions 



76 MEDICAL AND SURGICAL ESSAYS. 

prevail, as in the East and West Indies, and on the coast of 
Central America. 

1. No officer or man will be permitted to be on shore before sunrise or after 
sunset, or to sleep there at night. This rnle to apply not only to the conti- 
nental coast but to the Cape tie Verde Islands. 

2. No United States vessel will ascend or anchor in any of the African 
rivers, except upon imperative public service. 

3. Boat excursions up rivers, or hunting parties on shore, are forbidden. 

4. Vessels, when possible, will anchor at a reasonable distance from shore ; 
far enough not to be influenced by the malaria floated off by the land breeze. 

5. Convalescents from fever and other diseases, when condemned by 
medical survey, are to be sent to the United States with the least possible 
delay. 

6. When the general health of a ship's company shall be reported as im- 
paired by cruising upon the southern or equatorial portion of the coast, the 
earliest possible opportunity will be given them to recruit by transferring 
the ship for a time to the Canaries or other windward islands of the station. 

7. Boat and shore duty, involving exposure to sun and rain, is to be per- 
formed, so far as the exigencies of the service will permit, by the Kroomen 
employed for that purpose. 

8. All possible protection from like exposure is to be afforded to the ship's 
company on board; and the proper clothing and diet of the crew, as well as the 
ventilation and care of the decks, will bemade a frequent subject for the inspection 
and advice of the medical officers. 

9. These regulations are to be considered as permanent, and each com- 
manding officer of the squadron, on retiring from the station, will transfer 
them to his successor. 

The danger of sleeping or remaining on shore after dark in 
malarial climates, on account of the greater activity of the 
morbific cause at that time, is generally understood, while the 
universally admitted atmospheric contamination implied in the 
use of the word malaria, though its particular character is not 
known, points to the prime necessity of keeping as far away 
from its influence as possible by avoiding anchorages in narrow 
streams and inlets and to leeward of prevailing winds, and by 
intervening such a surface of water as has been practically 
found to confer immunity, through the surmised absorption of 
the aerial poison. Hammond quotes the following paragraph 
in point, from Sir Gilbert Blane : " I have known a hundred 
yards in a road make a difference in the health of a ship at 
anchor, by her being under the lee of marshes in one situa- 
tion and not in another." This has often been remarked in the 
bay of Rio de Janeiro, and by Surgeon Bloodgood, United 
States Navy, in the harbor of Panama, when the Jamestown 
was so terribly scourged by yellow fever. In the British ad- 
miralty health reports it is stated that "the Hiberuia, at 



MEDICAL AND SURGICAL ESSAYS. 77 

Malta, (luring the cholera, was moored within one hundred yards 
of the infected districts, and the ship remained throughout the 
whole pestilence free from any fatal attack." 

The fifth, sixth, and seventh of Secretary Preston's regula- 
tions are so exceedingly important that every infraction of 
them should be visited with the severest censure of the Depart- 
ment. Invalids should be sent home without delay, vessels 
should temporarily change their cruising grounds, and crews 
should be relieved as much as possible from duty, especially 
menial drudgery, involving exposure to sun and rain. Mose- 
ley and other writers on tropical climates advise that all 
merely laborious work should be performed by negroes, lascars, 
coolies, and others inured to the climate. As the Government 
authorizes the employment of Kroomen on the coast of Africa 
for boat and shore duty, many vessels of the Asiatic fleet have 
been provided with Chinese "fast-boats," manned by natives; 
but some commanding officers, either with a desire to save ex- 
pense, or because they consider that " men are shipped for any 
work, and if they die their places can be supplied by others," 
compel their crews to do this duty, at all times of the day, in 
any weather, and at any season. The cost of the fast-boat, 
however, is more than ten times defrayed by the saving of 
health. Admit that only ten men become ill from exposure to 
the heat of a single tropical summer, would it not have been 
more profitable to have had those men well and in efficient 
condition, than encumbering the deck with their cots, incom- 
moding their shipmates, and interrupting the ordinary routine 
of exercise ? Probably half of them will require to be invalided 
and returned to the United States, and the cost of passage 
home, the payment of wages. for services never performed, and 
those of the green recruits, who supply the invalids' places, the 
subsistence of the latter for months at a naval hospital, and their 
subsequent pensioning for the balance of their lives, would have 
employed a score of native boats with crews unaffected by the 
climate, and given to the Government the strength and spirit 
of these five men to fight its battles. The other reason adduced 
for not employing Chinamen, which is no fiction, since it was 
advanced to me, is disgraceful to the character of an American 
officer. That it is not the theory of the Government is 
evident from the general order 6f January 23, 1850. The sea- 
man is hired for other purposes than those of pulling pleasure 
parties of officers to and from the shore when the thermometer 



78 MEDICAL AND SURGICAL ESSAYS. 

stands above 100° F. He has devoted his life to the service of 
his country, and stands ready to shed his blood in its cause. 
The ship's batteries are that country's defenses, and he should 
be kept in a condition to man them. Without his strength and 
bravery, what will avail all the skill of the navigator, all the 
seience of the ordnance officer, or all the planning and maneu- 
vering of the commander? 

Besides avoiding the exposure of men by not sending them 
out of the vessel at improper hours, they should be protected 
on board ship from intense tropical heat both at sea and in port. 
Awnings ought always to be kept spread, fore and aft, when 
the temperature exceeds 80° F. They should protect not only 
the poop and quarter-deck, but the main-deck, forecastle, and 
head. As the awnings in port are usually very high from the 
deck, the protection they afford will be insufficient unless cur- 
tains are attached. They should be set before the spar-deck is 
perfectly dry, if it has been washed, that the slow evaporation 
may assist in keeping down the temperature; and if the deck 
becomes dry and hot during the day, it should be occasionally 
irrigated. Painting the hull of a vessel of a light color very 
materially affects the temperature of the covered decks. The 
tops should be provided with awnings, that those men on duty 
aloft may find a shelter when not on the yards or in the rigging. 
The lookout on the topsail-yard should also be screened and 
relieved every half hour, or, in calm weather, at shorter inter- 
vals; and if this is impossible, should be dispensed with, except 
when imperatively necessary for the safety of the ship. Many 
men are victims to the routine of keeping lookouts aloft, when 
it would be sufficient to have them in the tops or even on deck. 
The sentries on post in the gangways should be protected by 
small awnings or flies, and they should be frequently relieved. 
Numerous cases of coup-de-soleil occur among this class, who 
are made to parade a gang-plank two hours at a time, dressed 
in a closely-buttoned uniform, and carrying a heavy musket and 
accouterments, without any more attempt at shelter than would 
be afforded in their own temperate climate. A pensioner on 
the Navy list, some time since residing in New York, who is 
affected with hemiplegia, consequent upon insolation, was dis- 
abled under precisely such circumstances; and several others, 
which resulted less seriously, occurred on board the same ves- 
sel in the East Iudies. When boats are required to be sent 
away in the hot part of the day, their awnings should be spread, 



MEDICAL AND SURGICAL ESSAYS. 79 

and this manifestly applies to the very largest launch and small- 
est dinghy, as to those ordinarily used. * 

h\ very hot weather (above 85° F.) no work nor exercise of 
any kind should be performed after 9 a. m. nor before 5 p. in., 
unless absolutely indispensable at that time, and then only 
under shelter, and the reasons for such unavoidable work or 
exercise should be entered on the log. Tarring rigging, scrap- 
ing spars, scrubbing copper, painting ship, divisional exercises, 
small-arm drill, &c, at such a time, are barbarous, because inex- 
cusable. The dangers that are sought to be avoided are neither 
imaginary nor exaggerated. I have seen a new fore-topsail bent 
at 11 o'clock on a calm morning, the thermometer indicating 
126° F. in the sun, and followed by the fatal sickness of the 
captain of the top, and the serious illness, within forty-eight 
hours, of seven of the men who had been at work upon the 
yard. The weather was pleasant all day long, and others con- 
curred with me that the work could have been as well done 
early in the morning or late in the evening. Dr. Maclean, in 
Reynolds's "System of Medicine," relates the best historical 
instances of insolation occurring in the field or barracks, among 
the most striking being the following : "Of the two wings of 
Her Majesty's thirteenth regiment, which marched, after some 
very ill-judged exposure and drilling in the sun, from Nuddea 
to Berampore in the midst of the hot weather, and as the result 
of one march, the day closed with a sick-list of sixty-three, and 
eighteen deaths in all." "The sixty-eighth regiment, quartered 
in Fort St. George, Madras, which attended the funeral of a 
general officer, and paraded in full dress at an early hour in the 
afternoon, in one of the hottest mouths in the year, their tight- 
fitting coats buttoned up, their leather stocks as stiff and un- 
yielding as horse collars round their necks, heavy cross-belts, 
so contrived as to interfere with every movement of the chest, 
heavy shakoes on their heads, made of black felt, mounted with 
brass ornaments, with wide flat circular tops, ingeniously con- 
trived to concentrate the sun's rays on the crown of the head, 
and without protection in the way of a depending flap for the 
neck ; so dressed, the men marched several miles. Before the 
funeral parade was over, the soldiers began to fall senseless j 
one died on the spot — two more in less than two hours. Men 
suffering from insolation in various degrees were brought into 
hospital all that night and part of next day." "The ninety- 
eighth came from England in the Belleisle, an old 74-guu ship, 



80 MEDICAL, AND SURGICAL ESSAYS. 

and suffered from overcrowding. On the 21st of July they 
took part in the attack on Chiu-Kiaug-Foo. The men were 
dressed precisely as those of the sixty-eighth. In this condi- 
tion they had to take possession of a steep hill exposed to the 
fiercest rays of the sun shining out of an unclouded sky. A 
great many were struck down by the heat, of whom fifteen 
died." The most recent instance of criminal disregard of sani- 
tary teachings has occurred since I began writing. The first 
battalion of the tenth regiment of British infantry was marched 
from its camp to Yokohama' after parade on the morning of Au- 
gust 8, 1871, to the French Hatoba, where it embarked. The 
men were heavily armed and accoutered, and though exposed to 
the sun less than three hours, the thermometer at 92° F., shade 
temperature, five cases of sunstroke occurred, of which three, 
two sergeants and a private, died. Three of the marines who 
relieved them, and who were landed immediately afterward 
and marched to the camp they had vacated, also succumbed to 
the heat. 

The symptoms of insolation often occur among mennot exposed 
to the direct rays of the sun — in the fire-room of steamers, on 
board the monitor class of armored vessels, in small, ill-venti- 
lated cells. Dr. Kitchen informs me that while surgeon of the 
monitor Dictator it was common for men to be brought to him 
for treatment with coma, stertorous respiration, great heat of 
skin, full quick pulse, and often convulsions. The cause was 
manifestly enough the exhausting labors of a watch in the fire- 
room, where the temperature averaged 145° F., and where the 
ventilation was exceedingly defective, air that had been already 
respired being repeatedly returned. Maclean states that ''in- 
solation has frequently been observed on board ship, but almost 
always under conditions similar to those in barracks — that is, 
where overcrowding and impure air are added to the influence 
of excessive heat. Insolation is not uncommon on board the 
mail steamers, as in the Bed Sea in the hot months of August 
and September ; it has been observed that most of the cases 
occurred while the sufferers were in the horizontal position in 
their ill-ventilated cabins, and he quotes the following : " As- 
suredly," says Dr. Butler, surgeon of the third cavalry, " those 
barracks most crowded, least ventilated, and worst provided 
with punkahs and other appliances to moderate excessive heat, 
furnished the greatest number of fatal cases." Surgeon Long- 
inore, of the nineteenth regiment, notes that one-third of his 



MEDICAL AND SURGICAL ESSAYS. 81 

cases and nearly half the deaths occurred in one company of 
the regiment quartered in the barrack which was manifestly the 
worst conditioned as to ventilation, and, indeed, in every sani- 
tary requirement. M. Bassier, a surgeon in the French navy, 
reports that the man-of-war brig Le Lynx, cruising off Cadiz, in 
the month of August, had eighteen cases of insolation out of a 
crew of seventy-eight men. The heat was excessive (91-95° F.) 
and much aggravated by calms. The ship was overcrowded, offer- 
ing little space for the berthing of the crew. M. Bondin quotes 
the case of the French man-of-war Duquesne, which, while at 
Bio de Janerio, had a hundred cases of insolation out of a crew 
of six hundred men. Most of the men were attacked, not when 
exposed to the direct heat of the sun, but at night when in the 
recumbent position — that is, when breathing not only a hot and 
suffocating, but also an impure air. Other morbid conditions 
often attend or follow heat exhaustion. 1 have had two ma- 
rines on my sick-list with abscesses developed during confine- 
ment in sweat-boxes, in the months of June and August, in the 
tropics. In one the collection of pus was located in front of the 
neck ; the man was comatose, and, on recovering consciousness, 
complained of no pain. In the other it was developed on the 
upper arm, and was attended with throbbing pain and greatly 
increased heat of surface. In both the pulse was full, hard, and 
strong, the respiration labored and the body drenched with 
sweat, showing that the heat was as active a cause of disease- 
as the impoverished air. 

After a long and stormy passage through the Indian Ocean, 
the Levant arrived at Ariger Roads, in Java, on the 25th of 
March, 1856, when the heat was intense. Her crew were en- 
feebled and many of them exhibited evidences of the scorbutic 
cachexia, in consequence of the deteriorated and unsuitable 
character of their food, which the insufficient daily issue of 
wood did not allow to be properly cooked, of their short allow- 
ance of water, which was impure, and of their confinement on 
board ship since the previous October, when she went into com- 
mission, and their unusually arduous labors in the high southern 
latitudes, where they were exposed for several weeks to a con- 
tinuance of cold, damp, and rainy weather. Notwithstanding 
their condition they were laboriously employed working from 
daylight until dark for two days getting on board wood which 
was wet and green, and water, white from orgauic impurities, 
and which had run through a series of dirty wooden troughs 
6 M 



82 MEDICAL, AND SURGICAL ESSAYg. 

into au equally dirty reservoir. The vessel sailed on the even- 
ing of the third day, and within a few hours that night twenty- 
four cases of cholera communis were reported, two of the 
lieutenants among the number. Few of these men were ever 
able afterward to do their duty properly. As events proved, 
this was their preparation for a tedious passage of forty-six 
days across the China Sea to Hong-Kong, a distance of only 
twelve hundred miles, but entirely within the tropics, (latitude 
8° south to 20° north,) at the season of the change of mon- 
soons, when the high temperature is not moderated by any 
breeze nor the scorching heat of the tropical sun scarcely ever 
shielded by a clouded sky, aud when the glassy surface Of the 
sea reflects and concentrates the heat upon the ship whose 
black sides greedily absorb it. The deck-load of freshly cut 
green wood added an unwholesome moisture to the atmosphere,, 
and the unflltered water, with which the tanks had been filled, 
preferred for cheapness, soon decomposed and became offensive 
and unpalatable. The men had gorged themselves with oranges, 
mangosteens, and other fruit during their short stay at Ariger ; 
but the supply of chickens, vegetables, and fruit which they 
brought away with them was soon exhausted, and they were 
again fed with the mahogany-like "salt horse," green, fat pork, 
worm-eaten bread, weevilled beans, and musty rice which they 
had had to eat in the chilly regions of the Southern Ocean. 
The paltry interval of three days in ninety-seven had brought 
no relief to their jaded and debilitated bodies ; but they were 
occupied with the still severer labor of working ship for every 
" cat's-paw" under the additional morbific influence of a verti- 
cal tropical sun. Most of the intractable cases of diarrhoea 
and dysentery, aud the large majority of deaths during the 
cruise, can be directly traced to this period. The asthenic habit 
of constitution, which rendered these complaints fatal, was evi- 
dently fixed upon them by the various concurrent circumstances 
in operation thus early in the cruise. After her arrival ou the 
station, this vessel did not, like the rest of the squadron, em- 
ploy a Chinese fast-boat, and the results of this and other 
violations of hygienic mandates were plainly shown in a sick- 
list of thirteen hundred and forty-Jive cases during the thirty 
months of her commission. .Nor were the sickness and ineffi- 
ciency of the crew the only consequences of this utter disregard 
of sanitary laws. One of the officers who inspected her at the 



MEDICAL AND SURGICAL ESSAYS. 83 

end of her cruise, told me that she was the most unclean, and 
ill-conditioned vessel lie had ever seen. 

Much of the sickness which is attributed to visiting' infectious 
ports arises from the foul condition of the holds and limbers of 
the vessels themselves. Although the fever might not have 
appeared but for the visits to the port, it«s equally true that it 
would not have been developed but for the uncleanness of the 
ship itself. The decay of the wood of the vessel and of the chips 
under the floor ceiling, the leakage, of brine from provision casks, 
and of molasses and vinegar from the spirit-room, the drippings 
of oil from the machinery of steamers, the sifting of coal-dust 
from the bunkers, and of ashes from the fire room, the influx of 
salt water, its admixture with fresh spilled from the tanks and 
the consequent death of the microscopic organisms which 
inhabit it, together form a putrescible mass, the malarious ema- 
nations from which pervade the vessel and occasion a general 
predisposition to zymotic and paroxysmal febrile affections; 
therefore, while so much attention is being given to the avoid- 
ance of unhealthy localities, let some little be paid to the smoul- 
dering pestilential tire — the artificial marsh over which so many 
human beings are living in fancied security. On this point 
very valuable testimony is borne by the annual report of the 
Health of the Navy, issued by the British admiralty, for the 
years 18G5-'GG: "The Madagascar was long infected with 
yellow fever at Bio de Janeiro, and when inspected it was dis- 
covered that the sides of the ship and the lining were in many 
places decayed, damp, and rotten, and on lifting the limber- 
boards a quantity of black, offensive mud was discovered, the 
smell of which caused nausea, vomiting, and diarrhoea in several 
persons present." It is also stated in the case of the Isis, at 
Sierra Leone, that "there can be no question that the existence 
of the fever-poison in that vessel depended neither on the 
locality, but on the vessel itself," the latter even becoming a 
focus from which infection spread to other vessels, since 
"within six or seven weeks no fewer than twenty-eight deaths 
among the crews of two ships-of-war, from this malignant fever, 
were clearly due to communication with the Isis; all these 
deaths occurring exclusively among men who had gone on board 
that vessel." It is a point of great practical interest in respect 
to severe outbreaks of yellow fever on board ship, that "nearly 
all the vessels which, have been most scourged in late years 
were unmistakably unhealthy ships, as evidenced by their 



84 MEDICAL AND SURGICAL ESSAYS. 

larger number of ca^es of general sickness, not only during the 
yellow fever years, but also in those which preceded or followed 
them. This was the case with the Aube, Icarus, L'Eclair, and 
the same holds true of other vessels which have sustained fatal 
attacks of fever." The reputation of the L'Eclair was such that 
to efface the remembrance of the terrible disease the admiralty 
changed her name to Rosamond. 

There is no question of the propriety of preventing access to 
a vessel of which the crew is affected with malignant, commu- 
nicable diseases, neither is there any doubt of the urgent neces- 
sity of removing every individual of that crew without delay to 
some healthy and isolated place on shore. The system of quar- 
antine, however, which proposes to imprison both sick and well 
upon the infected vessel until the endemic exhausts itself for 
lack of new victims, is a barbarous relic of popular ignorance 
and superstition. The sanitaiy regulations of the United States 
and Great Britain are sufficiently liberal, and at the large sea- 
ports are generally judiciously interpreted by the health officers ; 
but in Portuguese, and especially in Spanish ports, the most 
annoying, frivolous quarantines are still exacted. I have known 
a man-of-war to sail from Philadelphia in midwinter, arrive at 
Cadiz after a passage of forty days, and be quarantined for 
having no bill of health ; another, provided with the proper 
document, to be placed under observation because it did not 
bear the vise of the Spanish consul ; and a third, coming from 
a port where there was no such official, to have the same fortune 
because the law did not provide for such a contingency. On 
another occasion I protested, ineffectually, to the health author- 
ities of Fengal against the placing in quarantine of a detach- 
ment of officers and men who had gone to rescue a sinking 
merchantman, one hundred and fifty days out of port. Occa- 
sionally similar anuoyances are experienced in our own country. 
During the period of my official connection with the United 
States navy-yard near Portsmouth, New Hampshire, I had 
serious trouble with the local health officials, who refused to 
consent to the immediate debarkation of the crews of vessels 
sent north from the Gulf of Mexico, often with mild pseudo- 
yellow fever, though abundant opportunities existed for iso- 
lating not only the invalids and convalescents, but the unaffected 
crew and the abandoned vessel. The various health authorities 
of New York and the other municipalities fronting on the bay 
have been but lately engaged in disgraceful squabbles over 



MEDICAL AND SURGICAL ESSAYS. 85 

their several rights to grant pratique to vessels from suspected 
ports. Hence, it would be in the interests of commerce aud 
humanity if the whole subject of quarantine were placed under 
the control of sanitary officers appointed by the General Gov- 
ernment. Michel Leoy and Fonssagrives, in their respective 
works on hygiene, have protested energetically against the 
useless and ridiculous impositions of the system of quarantine 
in vogue, aud the medical officers of every navy are agreed 
that, no matter what the disease, both sick and well should be 
immediately removed from the vessel, which should be thor- 
oughly cleansed and renovated. The health reports of the 
British admiralty state: "Within the last ten or twelve years 
cases of yellow fever have, on more than one occasion, been 
landed from ships of war in Plymouth and Hasler hospitals 
without any but good results. The results in Jamaica, in 1860, 
were eminently satisfactory. The same seems to have been the 
case in 1856, the most sickly year, when fever was prevalent on 
shore at Port Royal aud Kingston. In the numerous instances 
of late years where crews, sick and well, have been lauded at 
the island of Ascension, the disease seems to have speedily 
much abated, and in no instance to have extended to the gar 
rison and other residents, always provided that direct commu- 
nication with the infected ship was prevented ; and deputy 
inspector general Dr. Smart, royal navy, relates striking proofs 
of the utility of landing the sick in suitable hospitals at 
Bermuda. 

MORAL INFLUENCES. 

The sailor of to day is not the brute of fifty years ago. The 
barefooted, abject, illiterate being whose back bore the scars 
of the cat is not recognizable in the well-dressed, tidy, manly- 
looking seaman who receives his letters and papers regularly 
from home, and signs his name legibly to the shipping articles. 
The many foreign officers and civilians who witnessed the 
memorable inquiry into the circumstances attending the loss 
of the Oneida, at the British consulate at Yokohama, were 
impressed with the intelligent, tearless, and manifestly truth- 
ful manner in which the surviving lookout and helmsman gave 
their evidence, and particularly with the graceful style in which 
they affixed their names to the record. While it was once 
almost unnecessary to inquire whether a man could write his 
name, it is now the exception that "his + mark" appears on 
the rendezvous returns. The well-tilled conditions of the 



86 MEDICAL AND SURGICAL ESSAYS. 

various ship letter-bags, and the general allotment of half-pay, 
attest the commendable home interest of the modern sailor. 
The qniet, dignified old quartermaster, who off duty sits con- 
ning his Bible; the young quarter-gunner reading stories and 
travels to a crowd of listeners ; the ambitious ordinary seamen 
working out problems from the Bowditch borrowed from the 
navigator, are now to be seen on board every vessel of war. 

There are some naval officers, generally themselves anti- 
quated, who insist that the social improvement of the sailor 
has been at the expense of discipline and nautical knowledge; 
but there are others of equal experience and brighter minds 
who candidly acknowledge the contrary. The abolition of the 
cat was a natural consequence of this moral advancement; 
therefore the advocates for its restoration are only attempting 
to reinoculate a convalescent body with the virus of the dis- 
ease from which it has recovered. The necessity of former 
times, if there ever was such, has ceased, as witness the testi- 
mony of Fonssagrives, whose exhaustive work on naval 
hygiene establishes his authority : " We do not believe that 
the sailor of to-day is that of 171)0; he has changed with the 
public character, and to desire to treat him in the same man- 
ner is to commit a flagrant anachronism. Physical suffering 
is, moreover, a bad appeal to make among men, who are 
neither degraded nor vicious. This punishment excites hate 
more often than repentance, and has never reformed any one. 
The abolition of flogging, therefore, is a judicious measure. 
Besides this punishment, like that of ' keel-hauling,' may be 
followed by grave accidents — sometimes mortal — and that 
alone should suffice, without any motive of moral propriety, to 
justify its abandonment." What is true of the soldier is also 
true of the sister profession of arms. "The day when sol- 
diers were regarded as mere machines has passed away. An 
intelligent man, who knows what he is fighting for, and who 
is capable of appreciating the responsibility that rests upon 
him, is incomparably a better soldier than one who is incapable 
of such intelligent action." — Hammond. It is not claimed 
that all sailors are so exemplary ; nor is it expected that all 
the profane, licentious, and drunken will ever be, transformed 
into upright, intelligent, well-conducted individuals. Although 
the general character has improved, great numbers are as 
depraved as they can become by unrestrained indulgence of 
their passions. The low haunts of maritime cities are still 



MEDICAL AND SURGICAL ESSAYS. 87 

crowded, and the man-of-war's man, though distinguishable by 
dress and bearing, lends himself to -the general debauchery, 
and becomes as helpless a victim of the land-shark. 

What can be done to correct these evils? Though it be no 
more possible to confer on every one the boon of moral health 
than to bring their bodies all into a condition of physical 
eucrasy, enough good may be achieved to reward all our efforts 
bountifully. Teach the sailor that lie is a man, with a man's 
duties and capacities. Treat him as such, and require him to 
act as such. Develop his mind, which has been subordinate 
to his physical instincts, and that mind will do for him what 
legislative action or individual beneficence cannot. Ethical hy- 
giene is a field in which every naval officer, and those of the 
medical corps particularly, should not be ashamed to labor. 

I would first suggest, for the moral improvement of the sailor, 
that every vessel should be furnished with a library; not such 
as is now found in the cabin, behind a glass case, but a library 
to which every man on board can have access. Exclude sensa- 
tional novels, and let it consist of works on natural history, 
general history, and historical romance, travel, geography, 
popular science, encyclopedia and magazines, biography, navi- 
gation, and school-books — some rudimentary, and others for 
advanced students. If these are not supplied by the Govern- 
ment, as is desirable, they can always be obtained, without 
much trouble, by subscription. They should be placed under 
the charge of the schoolmaster, or some other intelligent petty 
officer, as the apothecary or paymaster's writer. Arrangements 
may readily be made with publishers to have files of newspapers 
mailed to vessels in foreign stations. Many officers consider- 
ately send their papers out on the berth-deck after having 
perused them. Keligious associations, interested in the moral 
melioration of the seamen, occasionally make donations of pack- 
ages or boxes of books to sea-going vessels; but these are 
always so unattractively pious and devotional that the sailor, 
with evideut disappointment, lays them aside, after endeavoring 
to read a page or two, and returns to his dominoes or checkers, 
wdien an interesting tale of travel or adventure pleasantly told, 
or an intelligible account of natural phenomena or scientific 
facts would have secured his atteutiou, and contributed as well 
to his moral as to his mental culture. Men should be encour- 
aged to write home, and I have, therefore, advised that ditty- 
boxes should be allowed in preference to bags, since writing 



88 MEDICAL AND SURGICAL ESSAYS. 

materials cannot only be better preserved in tbein, but they also 
serve as writing-desks. Some competent person should be 
appointed schoolmaster, not only to instruct the boys, and such 
others as desire to learn, in reading, writing, arithmetic, and 
geography, and should not be diverted from his legitimate duties 
to act as "executive officer's clerk." 

It is not enough, however, to increase the comfort of the sea- 
man on board ship to supply him with reading matter and' to 
provide for his instruction. He will not be well if he never 
leaves the ship. Hygiene demands nothing more important, 
not merely for their physical well-being, but for their mental 
and moral healthfnluess, than that the men should be allowed 
frequent liberty on shore. I have known a whole ship's com- 
pany, except the boats' crew, servants, and a few privileged 
petty officers, to be confined eight months on ship board, with- 
out, in all that time, having once touched foot on land. Is it a 
matter of wonder, then, that when liberty was granted for forty- 
eight hours, at such long intervals, when old and young, adults 
and boys, were hurried on shore together, and told if they re- 
turned before the expiration of that time they would forfeit the 
remainder of their liberty, that in the delirium of finding them- 
selves outside their prison walls they abandoned themselves to 
unrestrained debauchery ? Was the spectacle of bruised and 
bloated countenances, of which the ship was full for a fortnight 
after this season, calculated to improve the younger portion of 
the crew, or, as often happened when these youngsters were 
themselves the most riotous offenders, did their display, ironed, 
gagged, and bucked upon the poop, in the full view of the har- 
bor, convince them of their folly and sinfulness? Dr. Wilson 
relates an instance which exemplifies the utter thoughtlessness 
with which some officers deal with these matters : k< After a 
ship had been at anchor for several mouths in a foreign port, 
without any of the crew having been permitted to visit the 
shore, in a summary court trying a culprit I heard one of the 
members express his views by suggesting that the prisoner be 
sentenced to the seventh punishment, 'deprived of liberty on 
shore in a foreign station.' " The mysterious laws of health, 
psychical and physical, require that a man should visit the 
land, walk upon the earth, breathe its atmosphere, and inhale 
the odor of its trees and flowers. Let a mau see something 
more of the ports to which he sails than the glimpse he catches 
through the bridle-port or over the rail, for strict discipline does 



MEDICAL AND SURGICAL ESSAYS. 89 

not permit a head to show above it, that he may not have to 
make the mortifying admission when he returns home that he 
has never been on shore. Let him have au incentive to read, 
study, and inquire about the places he visits, and with what 
interest will he visit them ? Make the visits to the shore no 
longer a uovelty and a recognized occasion for plunging into 
orgies aud dissipation, but an opportunity for rational enjoy- 
ment, instruction, and exercise. That this is not a visionary's 
scheme was demonstrated by Commander, afterwards Admiral, 
Foote, on board the sloop-of-war Portsmouth, during her cruise 
in the China aud East India seas in 1856-57 and '58, when this 
system was pursued. Was this a well-disciplined ship ? On 
none in the squadron were there so little need, and so small 
a record of punishment. Was she clean and well condi- 
tioned ? Her executive officer, Lieutenant, now Commodore, 
Macomb, to whom I refer for couttrmatiou of my statements, 
well-deserved the flattering report of the board of inspection. 
Was she efficient as a man-of-war? The conduct of her officers 
and men at the attack and capture of the Barrier Forts, near 
Canton, is a matter of official record, and certainly bore com- 
parison with that of a sister ship on wmich a different practice 
prevailed." Did she maneuver well? There are many still in 
the service who were then on board other vessels, and who 
remember the pride they experienced whenever she entered the 
crowded harbor of Hong Kong, threaded her course through 
the many sail of every nation there congregated, aud anchored, 
without mishap, wherever her commander desired. Was she a 
happy ship ? Those who were fortunate enough to be attached 
to her agree that that cruise will be memorable, not only for 
its general interest, but for the harmony that pervaded the 
ship forward and aft, from the time of going into commission 
until the flag was hauled down. I do not desire it understood 
that this is an isolated case in the practice of our Navy. The 
book of Eegulations for the Government of the Navy, issued in 
1870, prescribes in paragraph 1429 that " petty officers aud 
men will be permitted to visit the shore on suitable occasions 
when it can be done without injury to the public service;" but 
the interpretation orthe terfns " suitable occasions" aud "in- 
jury to the public service," depends entirely on the will or 
caprice of the commandiug officer. I believe that these com- 
manders, who are pre-emiuent for professional skill and broad 
and liberal views of their duties and obligations to those under 



DO MEDICAL AND SURGICAL ESSAYS. 

tbeir command, without exception authorize the granting of 
frequent leaves of absence to their crews, though I have had 
but two opportunities of personally witnessing the effects of 
this system on board the men-of-war to which I have been 
attached during the seventeen years of my service in the Navy. 
These were the brig Dolphin, commanded by the present Ad- 
miral Steedman ; and the ship-of-war St. Louis, when under 
the command of Captain George Henry Preble. Men seldom 
look back with any great satisfaction upon the months they 
have passed away from home and country on a foreign cruise ; 
but I think few who were attached to these vessels, whether 
as men or officers, do not often recall the happy associa- 
tions connected with them. Throughout the many months 
the latter vessel was anchored in the harbor of Lisbon there 
was seldom a day that some of the crew were not on shore, and 
I remember not only the encomiums their conduct elicited, but 
on one occasion, when a disturbance at the circus was attri- 
buted to some of her men, with what promptness the journals 
of the city contradicted the charge, indicated the young gen- 
tlemen who had actually caused the difficulty, and intimated 
that these sons of wealthy and influential citizens might profita- 
bly imitate the behavior of the St. Louis sailors, who, of all the 
crews of the thirty men-of-war of various nationalities then in 
port, were welcomed on shore by the people. 

Liberty should not be granted to too many men at oue time, 
else the half-dozen incorrigibles who are found in every crew 
will make it an occasion for revenging private injuries or insti- 
gating disorderly conduct. Let it be understood that every day 
in porta single mess will be allowed to go on .shore, and that 
whoever returns drunk, dirty, disfigured, or with clothes torn 
or missing, shall forfeit his right to go when it next comes 
his turn. Let such offender, after, one deprivation, be again 
allowed liberty when his turn arrives a third time, and if again 
offending be permanently deprived the privilege. Let it also 
be understood that whoever overstays his leave compels the 
whole of the next mess to remain on board until he returns, 
and there will be few who will care to encounter the ill will of 
their shipmates by so doing, and whose purrishment will not be 
gladly witnessed by them. Opportunities for visiting the shore 
might also be multiplied by changing boat's crews weekly or 
semi-monthly, the coxswains only remaining the same. All 
hands would thus be able to partake of advantages now enjoyed 



MEDICAL AND SURGICAL ESSAYS. 91 

only by a few. The institution of the system of frequent liberty, 
besides the sanitary good it accomplishes, serves to reward the 
meritorious, punish the worthless, and operates as a more power- 
ful check to intoxication than pledges, lectures, or enforced 
abstinence. 

As in many foreign ports, efforts are being made to eradicate 
venereal disease by subjecting the public women to sanitary 
examinations, it is important that similar inspections be re- 
quired of men going on shore. Unless very frequent leaves of 
absence are granted, men invariably indulge, in sexual inter- 
course, whether diseased or not, and those affected with chronic 
gonorrhoea deliberately do so with the object of transferring 
the disease from themselves to the woman, a therapeutic effect 
which Jack has undoubtedly often observed, though he mistakes 
the rationale of the cure effected. Similarly well founded is 
his horror of the doctor's attempt to pre vent the suppuration of 
his " blue ball," for though ignorant of the distinction between 
. chancre and chancroi, he knows that a bubo that does not break 
will be followed by the horrible train of constitutional symptoms. 
As long as the sexual impulse exists it will be gratified, and if 
not naturally, by such expedients as can be adopted, and the 
ingenuity will be exercised to devise novel modes of excitation. 
I have never been attached to a ship in the service on board 
which manustupration and paederasty were not practiced, the 
latter, of course, more rarely than the former. Other officers 
may deny that they have heard of them, but I know these vices 
to be common, and generally unknown only because uninves- 
tigated or undiscovered. Frequent liberty on shore will re- 
move the great incentive to them, though, when the habit is 
established, this will not always serve to break it up, as witness 
certain cases well-known to medical officers in our own and 
the British navy among officers of high rank. Among the 
causes which formerly operated to enfeeble the sailor's consti- 
tution, and shorten his life, I have no hesitancy in includ- 
ing celibacy. Dr. Stark, as quoted by J)arwin, states that 
" bachelorhood is more destructive to life than the most uu- 
wholesome trades, or than a residence in an unwholesome house, 
or district, where there has uever been the most distant attempt 
at sanitary improvement " In former days, in our own service, 
and even now, where the systems of long enlistment and in- 
frequent leaves of absence prevail, the lnan-of-wars-man was 
virtually a celibate. I have known him return from an absence 



92 MEDICAL AND SURGICAL ESSAYS. 

of three or four years, reship for another cruise, sometimes on 
the morrow', often the same week of his discharge, and thus 
pass years within the narrow compass of a ship's hull. Mar- 
riage, under such circumstances, was only a form, and even 
with officers was little better. A friend now high on the list, 
out of the first eleven years of his married life had not passed 
a sum total of eleven months at home ; and another, a British 
naval officer of rank, told me that though he had been married 
twenty-two years, he had lived less than an aggregate of one 
with his family. Instances like these will probably never again 
occur, at least in our own service, since every officer is by regu- 
lation entitled to a period of shore duty after every full cruise 
at sea, and sailors who obtain honorable discharges are also 
allowed three months' full pay on shore. 

As an additional reward for good behavior, a liberal allow- 
ance of money should be made and withheld from the unde- 
serving for the purchase of books, curiosities, or presents for 
friends at home. Most men have some dear relative or friend 
for whom they desire to obtain some gift, and any expenditure 
for such an object should be sanctioned and encouraged. 

There is so little to stimulate the ambition of the sailor on 
board a man-of-war that the superior class of native Americans 
are deterred from entering the Navy. In the merchant service 
the seaman 'aspires to become a mate or master, and, if indus- 
trious, temperate, and qualified, he succeeds, while in the Navy 
he may be twenty years a petty officer without enjoying any 
increase of privilege over the ordinary seaman or landsman of 
as many days. His duties are more responsible, greater couli- 
deuce is reposed in him, greater deference paid to his opinion; 
but he dresses as he has always done, he squats at the same 
mess-cloth, and is as much a prisoner on board ship. The Army 
offers opportunities of advancement through the non-commis- 
sioned grades to the line of promotion, and all such meritorious 
preferments are welcomed to their new station with the cor- 
diality and public spirit characteristic of this arm of the 
national defense. It is a great defect in our naval organization 
that more distinction is not made between petty officers and 
the rest of the crew. Their dress should be strikingly distinc- 
tive; they should constitute a totally separate mess; they 
should be granted greater indulgences, among them that of 
going on shore three or four at a time when their duties permit, 
without reference to the liberty allowed the other messes. 



MEDICAL AND SURGICAL ESSAYS. 93 

They would then feel that the title officer was something more 
than a farce, and less deserving the adjunct "petty," and the silk- 
embroidered eagle on the arm would carry with it more respect 
than it does now under its familiar designation of " buzzard." 
The positions of mates and warrant officers should be recruited 
from this class, and special effort should be made to ascertain 
and report all men qualified for and ambitious of obtaining 
such situations. The condition of the non-commissioned offi- 
cers of the Marine Corps, who on shore are treated with the 
same consideration as the corresponding grades in the Army, 
is a peculiarly distressing one when they come on board ship 
and are subjected to the same restrictions and exactions as the 
petty officers with whom they are there classed; and many 
very excellent sergeants have been degraded and ultimately 
ruined by the humiliations which they have suffered in conse- 
quence of this system. The apothecary and yeoman, (the latter 
an unmeaning title for which storekeeper should be substi- 
tuted,) the one requiring a semi-professional education in phar- 
macy and the other intrusted with important pecuniary respon- 
sibilities, and probably also the schoolmaster, when one is 
allowed, properly belong to the class of appointed officers with 
the clerks of the commander and paymaster, and should mess 
with them in the steerage. Their duties require a far higher 
order of ability, for the clerks are only copyists, and their posi- 
tions would become attractive to young men- in the same gen- 
teel station in life were they removed from the coarse associa- 
tions of the berth-deck. Much of the illicit treatment, especially 
of venereal complaints, by which the apothecary, unless closely 
watched by the medical officer, will attempt to eke out his inad- 
equate salary, will be checked by giving this officer a status 
correspondent to the nature of his calling, as in the French, 
Brazilian, and other foreign navies. A still more important 
gain will be the getting rid of the class of imperfectly educated 
and broken-down drunkards, who now accept the position 
because their habits keep them from employment on shoi'e, and 
of the still worse class of incompetents provisionally rated 
from the deck, who, however carefully the hospital liquors may 
be kept under lock by the medical officer, will steal part of that 
issued to the sick, or drink or sell the alcohol from the spirit- 
lamp or that from the percolator while he is making tinctures, 
or even the tinctures themselves, and who never compounded 
a pill of calomel or quinine without running the risk of putting 



94 MEDICAL AND SURGICAL ESSAYS. 

up corrosive sublimate or strychnine, or who add half an ounce 
of some potent liquid to a mixture when the prescription called 
for half a drachm. 

The act of Congress establishing honorable discbarges and 
the institution of honorary badges indicative of every such dis- 
charge have accomplished .excellent results. Care should be 
taken that every man entitled to the distinction receives it, 
and further that none is issued except in meritorious cases. I 
have seen an honorable discharge presented at a rendezvous 
by a man who desired to reship as a seaman, that being the rate 
he bore on the discharge, who, when examined, was found 
unable to send down a top-gailant-yard or reeve a top-sail bunt- 
line, and who finally admitted that he had not been in a top 
the whole cruise, but had been coxswain of the barge and arbi- 
trarily rated seaman. The presentation of medals of honor, 
authorized by Congress, for conspicuous heroism during the 
rebellion, should be made a permanent institution. The pride 
with which Frenchmen display their little pieces of riband and 
the emulation excited among Englishmen by their Victoria 
cross and medal ought to have some parallel in the naval ser- 
vice of our own country. 

Ennui and home-sickness affect the sailor less than the officer, 
but the monotony of his occupation and the protracted confine- 
ment on board ship ultimately cause him to become despondent 
and indifferent to- his duties. Frequent occasions of visiting 
the shore and an abundance of reading matter will do much to 
dissipate these enervating feelings, but I would suggest, with- 
out intending to interfere with the business of any other depart- 
ment, as a further means of occupying and interesting him, 
that more attention be paid on board ship to the minor works 
of nautical manufacture. Every one has observed the general 
interest excited by the occasional weaving of sword-mats and 
the crowds that cluster around the sail-maker's seat, the car- 
penter's bench, and the armorer's forge. Would it not be 
instructive as well as interesting to multiply these occupations, 
even though no immediate necessity existed for them ? I do 
not suggest this, however, with the object of simply finding 
work for the crew. Spars, masts, and coamings have been 
scraped and painted, rescraped and repainted, and bright work, 
introduced wherever possible, blacked and polished, reblacked 
and repolished merely for the sake of keeping the men all the 
time occupied. Such unnecessary and distasteful work makes 



MEDICAL AND SURGICAL ESSAYS. 95 

every one discontented and unhappy, particularly when accom- 
panied with the announcement that there will be no Sundays 
on board the ship. The sailor has a considerable religious ele- 
ment in Ids character, and, though restive under long church 
services, he entertains a respect for everything sacred. In most 
vessels of the Navy the Sabbath is scrupulously observed. 
Saturdays also are very properly appropriated to the crew, that 
they may take their bags on deck, sew, arrange, and air their 
clothing, and examine their little possessions. 

The depressing influences of sea life are to be further over- 
come by encouraging amusements and diversions. Music has its 
influence upon the sailor, as upon the dweller on shore. Wit- 
ness how the fife causes him to redouble his exertions at the 
capstan when almost exhausted with fatigue. A ship with 
singers and instruments on board is always cheerful. The 
sounds of music, dancing, and laughter, which are heard toward 
sundown, indicate the contented crew, and wherever there are 
mirth and gayety there are not apt to be animosity and quarrel- 
ing. Dominoes, backgammon, and draughts are also sources 
of amusement. On foreign stations many crews endeavor to 
enliven their time by organizing theaters, glee-clubs, and negro 
minstrel companies, whose performances are often exceedingly 
creditable, while considerable ingenuity is displayed in getting 
up costumes and scenery. At other times they decorate their 
vessel for fancy balls, in which they themselves assume the 
characters, and 1 have known a dinner to be given by one ship's 
company to another, at which speeches were made that could 
not have been excelled by the officers. Often a little interest, 
encouragement, and pecuniary assistance from the officers will 
lead to undertakings of this kind, which might not otherwise 
have been originated. A magic lantern, with a proper set of 
slides, would be invaluable for the occasional entertainment of 
the crew, particularly if its exhibitions were accompanied with 
explanatory remarks by some of the officers. 

Boat-racing, gymnastic; feats iu the rigging and on deck, 
swimming, tishiug, hauling of the seine, and when the circum- 
stances of the place wdl permit, athletic games, as base ball 
on shore, washing clothes there, &c, will afford sport and 
diversion of incalculable benefit to the health of the crew, and 
contribute to the diffusion of a spirit of happiness and content- 
ment among them. Company maneuvers, target firing, boat- 
racing, and sailing are not only recreations but beneficial exer- 



96 MEDICAL AND SURGICAL ESSAYS. 

cises. Some divisional officers infuse so much interest in the 
ordinary exercises of the vessel by the enthusiastic, earnest 
and vivacious manner in which they impart their instructions, 
and by the zeal with which they perform their duties, that their 
men always work with alacrity and pleasure. 

While rewards, honors, and diversions, are thus multiplied, 
they must not be deprived of their value by inattention to the 
necessity of punishing evil-doers. Discipline is the soul of a 
man-of-war and implicit obedience to the constituted authori- 
ties is the prerequisite to discipline. It should be exacted of 
every man and officer on board, and the example of submission 
to superior authority should be set their crews by commanders 
and other officers themselves. Every regulation of the Navy 
Department, every order of the Honorable Secretary of the 
Navy, and every act of Congress should be faithfully and fully 
obeyed, in the spirit and according to the letter, else the officer 
violating them cannot conscientiously punish those who infringe 
his rules. 

There will be bad men on board all ships, who will interrupt 
their order and harmony, unless they are promptly and effectu- 
ally punished. The act of Congress, specifying the various 
allowable means of punishment, was wisely and humanely 
framed. The penalties prescribed are efficacious, affecting the 
moral nature rather than causing physical suffering, which 
may do permanent injury to the offender's health. The same 
spirit should actuate officers in imposing their lesser punish- 
ments. He who complains that he cannot manage a ship's 
company without his instruments of torture, only admits his 
unfitness for his position. A man of proper mental resources 
will find abundant means of bringing shame and mortification 
to the culprit, by the withdrawal of privileges, tbe deprivation of 
spending-money, the restriction of liberty, the imposition of 
extra duties, particularly those of a disagreeable kind, &c. 
The bad are also indirectly but effectually punished whenever 
the good are conspicuously rewarded. Although forbidden by 
law, recent courts-martial have disclosed that confinement in 
"sweat-boxes," or, as they are euphemistically termed, " the 
cells, " is still inflicted on board ships, at the risk of the life or 
jeopardy of the health of the man or boy, who may have been 
guilty of some trivial offense. Besides its illegality, it is of a 
class with bucking and sagging and tricing up by the thumbs, 
the toes only touching the deck, or lashing on the inside of the 



MEDICAL AND SURGICAL ESSAYS. 97 

rigging, the bare soles on the rattlins and rope yarns cutting 
into the wrists and ankles — barbarities unworthy the nineteenth 
century. As drunkenness is the source of most of the disturb- 
ances on board ship, if carefully guarded against there will 
never be occasion for gagging a man raving with alcoholic 
mania. When such cases do occur, rather than resort to means 
which aggravate the nervous symptoms and may occasion irrep- 
arable injury, let them be handed over to the medical officer, 
who by a little judicious treatment can soon quiet them. Pun- 
ishment is thrown away on men whose brains cannot perform 
their functions. When reason and consciousness are restored, 
it will be appreciated and be of profit. No one thinks of gag- 
ging the noisy victim of delirium tremens, yet it would be as 
rational to do so as to try to smother the voice of the yelling 
inebriate. 

THE SICK-BAY. 

It is, of course, the paramount duty of the medical officer to 
provide for the comfort of the sick. In frigates the forward 
portion of the berth-deck is assigned to the sick-bay. This 
apartment is always disproportionately small, usually badly 
ventilated, imperfectly lighted, sometimes very wet, often foul 
and offensive from leakage from the head pipes, which lead 
through it, and disturbed by the noise of the chain cables in 
coming to anchor or getting under way: The Guerriere and 
Tennessee are representatives of the finest and largest of the 
vessels of the modern navy. The former is a first-rate of about 
2,500 tons, carrying twenty-one guns; the latter a second-rate 
of 2,135 tons^ with a battery of twenty-three guns ; and both 
are manned by crews ranging from three hundred and fifty to 
five hundred men. The length of the berth-deck of the Guer- 
riere is 310 feet, its average breadth 28 feet, and its height 
between decks 6 feet 11 inches ; the corresponding measure- 
ments of the Tennessee's berth-deck are 334 feet 4 inches length, 
27 feet 9 inches average breadth, and 7 feet 3 inches height; 
yet the sick-bay of the former has a cubic capacity of only 
2,275 feet, scarcely properly accommodating three patients; 
and of the latter 4,807 feet, not more than is required by five. 
Important as is this portion of the vessel, its dimensions are 
rather a matter of accident or subordinate to other consider- 
ations, than regulated by the numerical size of the crew, the 
fitness of its location, the nature of the cruising ground, and 
7 M 



98 MEDICAL AND SURGICAL ESSAYS. 

the probable amount of sickness. Unless the sick-bay can be 
removed to its proper site aft, it should be. very much enlarged 
and made as comfortable as possible. Two or more air-ports 
should open into it on either side, and a scuttle or hatchway 
should be cut through the decks overhead for the admission of 
a wind-sail from either the spar-deck or, weather permitting, 
from the forward gun-deck ports. Several thick glass deck- 
lights should also admit light from the gnu-deck. The entire 
bulkhead of the sick-bay should be made of light gratings, 
which should not be furnished with thick wool curtains, as is 
commonly done. This apartment should be as impervious to 
water as it is possible to make it, and no pretext should ever 
sanction the discharge of the men's water-closets through its 
interior. 

In sloops of war, brigs, and other single- deck vessels, the 
midship portion of the berth-deck is appropriated to the sick. 
Where there are midship lockers the mattresses are usually 
spread on top of them ; but this is inconvenient if the lockers 
require to be frequently opened, and as the hawsers, &c, which 
are usually stowed there, can be placed elsewhere, this space 
should be kept free from obstruction and devoted exclusively 
to the sick-bay. 

To insist upon the cleanliness of this apartment would 
be to impugn the professional qualification of the medical offi- 
cer, who, on board ship as in the bed-chamber on shore, 
regards this as a most important part of the treatment of every 
case. Everything should be scrupulously clean about the 
invalid. The canvas screen which isolates him, and the cot 
or hammock in which he lies, should be of natural whiteness, 
not soiled by grease and dirt ; his head should rest upon a 
white cased pillow, not be propped up by his boots or pea- 
jacket ; and a comfortable hospital mattress and clean sheets 
and counterpane should be substituted for his own rough soiled 
blankets. The patent close-stool, now supplied all vessels from 
the Naval Laboratory, admirably answers its purpose of pre- 
serving the atmosphere of the sick-bay and berth-deck free 
from contamination. One or two cots should always be in 
readiness for the use of the sick. Even when ill but a few 
days it is a great relief for the sailor, who has been bent like a 
bow in his hammock, to lie in a horizontal position, and be able 
to stretch himself out at full length. The present wooden cot- 
frame is a clumsy affair, that ought togive way to a light iron 



MEDICAL AND SURGICAL ESSAYS. 99 

frame, easily gotten ready for use. The ambulance-cot devised 
by Surgeon Gorgas,. United States Navy, for the especial pur- 
pose of transporting wounded men, ought to be supplied to 
every vessel. The cots containing fever invalids and other 
cases of serious illness should always be slung on the gun-deck 
of vessels with covered batteries, and when the weather will 
permit, such patients should be placed under the topgallant 
forecastle of spar-deck sloops. 

The medical officer must decide how far the healthy members 
of the ship's company are to be inconvenienced by the sick. 
Usually the humanity of the sailor and officer prompts them to 
sacrifice every selfish interest in behalf of their invalid ship- 
mates, but occasionally a churlish fellow is met who boasts 
that he has never been sick an hour in his life, and only grudg- 
ingly assents to or flatly refuses the requests of the medical 
officer. If the latter is known to be zealous, devoted, and self- 
sacrificing in the performance of his duties to the sick, he will 
seldom have any difficulty in having them properly cared for. 
I have had charge of cases of low fever and dangerous opera- 
tions where the successful issue was largely, if not entirely, 
due to the assiduous and intelligent watching of the volunteer 
nurses. Occasionally an officer will insist on the blind adher- 
ence to routine duty, notwithstanding the urgent representa- 
tions of the medical officer of the risk thereby occasioned to 
critical cases of sickness. Fortunate if no harm is done ; but 
I was a witness some years ago of death under peculiarly dis- 
tressing circumstances of this nature. A marine, exhausted 
by a severe pulmonary haemorrhage on the previous evening, 
was lying in a cot on the berth-deck on a Saturday morning, 
the usual day for holy-stoning the deck. Although the danger 
of moving the man was fully represented, he was carried on 
deck and placed under the top-gallant forecastle, the removal 
being followed within less than ten minutes by a haemorrhage, 
which quickly terminated fatally. 

Other circumstances the same, food, air, light, and attend- 
ance, I am satisfied that invalids will recover more rapidly on 
shore than in the best possible regulated hospital-ship. The 
most extensive experiment of this sort, which had then been 
made by our Government, was the Idaho, to the medical charge 
of which I was appointed in September, 1807. She was a steam- 
ship of the first rate, from which the machinery had been 
removed, and was stationed at Nagasaki, Japan, " to be used in 



100 MEDICAL AND SURGICAL ESSAYS. 

part as a store and hospital ship for the vessels of the Asiatic 
squadron." Although one of the largest vessels in the Navy, 
2,G38 tons, she proved unfit for this double and incongruous 
purpose. It was originally contemplated to devote the whole 
main (berth) deck to hospital purposes, but the part actually 
under medical control for the use of the sick only extended 
forward from the main-hatch to the water-closets, an area con- 
taining twenty thousand one hundred and sixty cubic feet 
of air space, within which the plan provided for fifty iron 
bedsteads. I erected, however, only forty, of which thirty 
were usually occupied, each invalid even then having only 
six hundred and seventy-two cubic feet of space. This was 
subsequently further largely intrenched upon by the erec- 
tion of prison cells for the criminals of the squadron on the 
forward portion of the hospital deck. Sir J. Banald Martin 
states, in this connection, that " each man should have from 
fifteen hundred to two thousand cubic feet of air space ; in 
very airy and exposed situations the smaller space will suffice." 
Among the most celebrated modern hospital establishments, 
the Lincoln Army General Hospital supplied fourteen hundred 
and forty-seven cubic feet of air space per man ; the Herbert 
Military Hospital at Woolwich, from twelve to fourteen hund- 
red ; the Blackburn Hospital at Manchester, seventeen hundred 
and ninety -four; the Lariboisiere, at Paris, from seventeen to 
nineteen hundred ; the Boston Free Hospital, sixteen hundred, 
and the Episcopal Hospital at Philadelphia' two thousand. 
Furthermore, according to Hammond, a ward containing 
twelve hundred cubic feet should have its air completely re- 
newed every hour, being at the rate of twenty cubic feet per 
minute, while a supply of thirty or forty is preferable. The 
ventilation of the Idaho was altogether insufficient, being 
effected solely through the ordinary small round air-ports, high 
from the deck and through the hatchways, wind-sails beiug 
usually conducted through the latter, but very often led into the 
hold beneath the hospital, where an immense quantity of pro- 
visions and steamer coal were stored, of which the gaseous pro- 
ducts of decomposition stained the paint- work, created noisome 
bilge-water, and rendered the atmosphere offensive. Large 
square ports through the ship's sides would have supplied a 
greater abundance of fresh air and mitigated these evils, but 
permission to have them cut could not be obtained. The sick 
were further inconvenienced by the incessant noises attending 



MEDICAL AND SURGICAL ESSAYS. 101 

tlio daily evolutions of a man-of-war, which were regularly and 
completely carried on by the working of the great guns and 
howitzers ; by the exercise of small-arm men and with broad- 
swords and single sticks; by the tumult and uproar of divis- 
ional and especially of general quarters ; by the receipts and 
discharge of coal and provisions for the squadron which had no 
other outlet nor inlet than directly through the hospital ; by 
the trampling of men overhead ; by the frequent drum beats ; 
by the shrill whistling and loud bawling of the boatswain's 
mates ; by the trumpet-sounded orders of the officer of the deck ; 
by the piping of the side when officers came on board or left 
the ship ; and by the loud clanging of the bell striking every 
half hour in tones heard at every bungalow on the hill side. 
For a vessel to be as efficient as possible for hospital purposes, 
it must be absolutely disconnected from every other duty, and 
even then it will lack the advantages of the hospital on shore — 
the qirietude, space, lightness, airyness, the shaded gardens for 
exercise, and that indescribable influence of the laud itself, to 
which I have elsewhere referred. 

When invalids must be treated on board ship, they should 
be sent on shore for exercise, under proper surveillance, as 
soon as convalescent. They who have this privilege will re- 
turn to duty much sooner than those restricted to the ship. I 
have seen men slowly lingering weeks and months in a dark, 
stifling sick-bay in the bows, hanging in a greasy hammock, 
wrapped in soiled blankets, without sheets or other pillow than 
their boots or pantaloons, a dull looking tin pint-pot of cold 
nauseous tea or coffee and a piece of hard tack, or a black tin 
pan containing a chunk of salt meat, stuck on a beam beside 
them, who were ultimately invalided and discharged from the 
service, who comfortably circumstanced on a light airy deck, in 
a clean cot, between white sheets and properly bathed and fed, 
would soon have been able to have been carried on deck in a 
chair, for an hour's exposure to the sunshine, then taken on 
shore by a nurse for daily exercise, and finally discharged to 
duty. The medical officer should not detaiu a man on the sick- 
list a day longer than is necessary. His paramount duty is to 
maintain the personnel of the vessel in the most efficient condi- 
tion, and when this is deranged to restore it without delay. No 
man, however, should be returned to duty until fully able to 
perform the work required of him, and any physician who could 
be guilty of such a violation of professional trust would justly 



102 MEDICAL AND SURGICAL ESSAYS. 

deserve the contempt of his brethren and the scorn of all good 
men. 

The practice of indiscriminate invaliding is exceedingly 
demoralizing. Men, in order to get away from ships which 
they dislike, feign sickness, or, when really ill, endeavor to 
retard their recovery ; and, if discharged from the sick-list, 
present themselves again and again at the dispensary, seeking 
to establish such a reputation for physical inability or worth- 
lessness as will accomplish their object of getting surveyed and 
sent home. There are not a few officers in the Navy, professing 
valetudinarians, who offer themselves as candidates for survey 
whenever disagreeable, arduous, or dangerous duty is assigned 
them, and who, through the good nature, credulity, or negli- 
gence of the medical boards, generally gain their end. Not the 
least evil attending the invaliding of numbers of a crew is the 
necessity of shipping other men on a foreign station to supply 
their places, and experience has shown that a very large pro- 
portion of such recruits very soon themselves come under 
treatment for constitutional diseases which were undiscoverable, 
and which they swore did not exist, at the time of shipment. 
During the past summer 1 received a letter, dated at Callao, 
from Dr. John S. Kitchen, the surgeon of the United States 
steamship California, en route to join the Pacific fleet, stating: 
" We have on board six chronic diarrhoeas and two epilepsies 
from the St. Mary's, all enlisted on this coast within six or eight 
mouths. Every one of them acknowledged that he had the 
disease before enlisting." Hence, a system of properly organ- 
ized temporary hospitals on shore, at the headquarters of the 
several stations, will save the Government a large expenditure 
of money and an enormous waste of excellent physical mate- 
rial. Men, however, who have actually succumbed to climatic 
influences, should be sent home, not by " the first public con- 
veyance,' 1 which may necessitate months of waiting, but by the 
earliest opportunity, without regard to expense ; since the 
sooner they are removed from the deleterious climate, the sooner 
they will be able to do duty elsewhere. 

The proper treatment of malingering, which is especially com- 
mon on board ships, to which inexperienced medical officers are 
attached, should occur to every educated physician. 

SANITARY REGULATIONS FOR THE NAVY. 

I have epitomized the proposed set of sanitary regulations 
which follow from the suggestions briefly tendered in the fore- 



MEDICAL AND SURGICAL ESSAYS. 103 

going pages, and submit them to my associates in the medical 
corps, and to such commanding officers as may be willing to 
apply to them the test of experiment, with a view to the ulti- 
mate institution by the Department, if not of these rules, of 
others Avhich may better accomplish the hygienic objects 
desired. 

Dryness, coolness, fresh air, sunshine, cleanliness of body, 
clothes, and bedding, good food, pure water, temperance, 
refreshing sleep, occupation, exercise, cheerfulness, and content- 
ment of mind are not only the best anti-scorbutics, but anti- 
dysenteries, anti-febrifics, and auti-morbifics in every sense. The 
hygienic precautions I have suggested receive an indorsement 
of unquestionable value from the following recommendations 
by Henneu, which, though intended for soldiers, are based 
upon those same general laws of health by which the human 
body is governed as well at sea as on laud : " The true prevent- 
ives to disease are shelter from the heat of the day, and from 
the dews and cold of night, avoiding the neighborhood of 
marshes, allowing men natural sleep, allowing vegetables in 
due proportion, a comfortable breakfast before duty in the niorn- 
ning, the daily exposure of bedding to the sun, the change of 
clothing after hot and rainy weather, flannel waistcoats or cot- 
ton shirts, frequent bathing, daily washing of the feet, and the 
serving out of spirits only in the evening." "If it be true, 
as it undoubtedly is," concludes Guy, in a review of the melior- 
ating influences exerted by sanitary science upon the British 
navy, "that by improvements in diet, water-supply and venti- 
lation, in clothing and cleanliness, aided by superior medical 
treatment, and especially by vaccination, and by an improved 
discipline, tempered by mental culture and amusement ; if it be 
that these improvements and reforms have saved life and pre- 
vented sickness to such an extent, that the effective force of our 
navy has been more than doubled, that one ship, for every pur- 
pose of navigation and warfare, is at least equal to two of the 
same size and force, that a vessel can now keep the sea for twice 
or thrice the time that was possible less than a century ago ; if 
it be true that, at the old rate of mortality, all Europe could 
not have furnished the seamen necessary for our defense and 
safety during the great revolutionary war, then it is a mere 
waste of words to argue that health, which is the strength of 
all who work, is the great source of power to nations in their 
peaceful labors as in their warlike struggles." If commanding 



104 MEDICAL AND SURGICAL ESSAYS. 

officers will listen to aud be influenced by the advice of medical 
officers, berth-decks and gun-decks will not be incumbered with 
cots and hammocks, division officers will not have to complain 
that their guns' crews are incomplete, the efficiency of the ves- 
sel will be promoted, and when emergencies arise, as during the 
rebellion, when the national honor has to be vindicated, there 
will be a strong, stalwart set of zealous men to fight side by 
side with their officers, and repay tenfold those who have had 
such anxious regard for their health and comfort. " But an 
army in hospital," says Sir Randall Martin, " as at Walcheren, 
at Rangoon, and in the Crimea — what availeth it to the states- 
man or the commander? It is au incumbrance — a waste — 
almost a nullity." 

I. The greatest care must be exercised in keeping all parts of 
the vessel, especially below the spar-deck, clean, dry, well 
lighted, aud thoroughly ventilated. 

II. The berth-deck and covered gun-decks will never be wet- 
ted, except for thorough cleaning, and then, only on very dry 
days, and not oftener than once a week ; and the operations of 
cleaning and drying will always be conducted as expeditiously 
as possible. Those men only engaged in the work will be 
allowed upon them, until they are perfectly dry. Hot water 
will be used, wind-sails set, ventilators opened, air-ports and gun- 
ports opened, when not dangerous, and drying-stoves heated. 
Mere wet swabbing of the deck will be strictly forbidden at all 
times, and scraping or dry-stoning resorted to instead. When 
a continuance of bad weather keeps the berth-deck wet, drying- 
stoves will be frequently lighted, aud it will be sanded, as also 
when any unclean work is about being undertaken. 

III. Particular care will be exercised iu keeping the hold and 
spirit-room dry. They will be thoroughly whitewashed every 
month, and be frequently ventilated by the introduction of 
wind-sails and ventilators. Whitewash will be used on the 
beams, bulkheads, and ship's sides of the berth-deck, in place 
of paint. 

IV. No casks, boxes, or other articles will be stowed in the 
hold, unless clean and dry. No wet coal, nor wet or green wood 
will be ever sent below the spar-deck. Dry days will be selected 
for provisioning aud coaling, unless the urgent necessities of 
the service positively forbid delay. 

V. All hatches, gratings, and ladders scrubbed or washed on 



MEDICAL AND SURGICAL ESSAYS. 105 

other days than those for the general cleaning of the berth-deck, 
will be cleaned and dried in the open air. 

VI. Awnings and boom-covers will be promptly spread or 
housed on the occurrence of rain. The men will be required to 
protect themselves by weather-proof clothing, and will not be 
permitted to sleep in wet clothes. The watches, when relieved 
at night, will be required tp remove their wet clothes, and 
deposit them in tubs, provided for their reception, where they 
will remain until piped up to dry. Boats' crews, returning wet, 
will also be required to change their clothing. 

VII. Particular care will be exercised in sheltering "the head" 
by a hood in rainy weather, and by an awning wheu the heat is 
intense. 

VIII. All wet or damp clothing and sails will be exposed to 
be dried without delay. 

IX. When bilge-water has formed, it is to be entirely dis- 
charged, and fresh water allowed to flow into the vessel. After 
the lapse of an hour this is to be again discharged, and these 
operations will be repeated until the water is brought up free 
from odor, but the quantity of water introduced should never 
exceed that usually indicated by the soundings of the well. 

X. Air-ports will be opened and wind-sails set whenever not 
attended with positive risk, and the latter will be kept care- 
fully trimmed. All the lowermost parts of the vessel, (includ- 
ing sail-room, yeoman's and officers' store-rooms, &c.,) will be 
frequently opened for ventilation. Every effort will be made 
to maintain a free circulation of air forward and aft on each 
deck. All bulkheads separating apartments or making sub- 
divisions of the vessel will be latticed or grated, above and 
below, when not at the sacrifice of strength. 

XI. Ventilators will be placed above every vessel in the 
Navy, and will be put in operation every night and morning, 
and in narrow tide-ways vessels will be kept sprung broadside 
to the prevailing wind. 

XII. Awnings will be kept spread while the temperature of 
the atmosphere exceeds 80° F., except after a continuance of 
rainy weather or during the operations of cleaning the lower 
decks. 

XIII. The exposure of the crew to the intense heat of the 
sun, especially in tropical climates, will be avoided by the 
performance of all labor or exercise not imperatively called for 
between these hours, before 9 a. in. or after 5 p. m. 



106 MEDICAL AND SURGICAL ESSAYS. 

XIV. Every man will be required to possess sufficient cloth- 
ing- to change twice if exposed to wet. 

XV. Flannel or woolen garments must be worn next the skin 
at all seasons; and frequent changes of under-clothing and 
habitual neatness and cleanliness of dress must be insisted 
upon. 

XVI. When the weather will permit, at least two wash-days 
will be allowed every week. 

XVII. Cleanliness of person will be required of every man. 
Swimming will be allowed when practicable ; if dangerous, a 
tub will be placed under the top-gallant forecastle, or the head- 
pump, or port-side of the manger, will be screened and used for 
general ablution. Any unclean man will be compelled to bathe 
under the supervision of the master-at-arms. 

XVIII. Firemen and coal-heavers will be afforded especial 
facilities for bathing, which, however, will be interdicted imme- 
diately after leaving the fire-room. 

XIX. Fresh food will be obtained every day, when possible, 
except the stay in port be prolonged, in which case it may be 
issued four or five times a week. Berth-deck messes will be 
allowed to carry potatoes, turnips, onions, &c, as sea-stores. 

XX. The crew will breakfast at 7 a. in., dine at noon, and 
have supper at 6 p. m. Hot coffee and biscuit will be allowed 
immediately on turning out. All meals, including tea and 
coffee, will be carefully inspected as to character of prepara- 
tion, and will be eaten on deck whenever the weather will per- 
mit. 

XXI. During a continuance of inclement weather the galley 
fire will be kept lighted all night, and hot coffee allowed the 
watches. 

XXII. No water for drinking will ever be received on board 
until it has been examined by a medical officer and pronounced 
potable. 

XXIII. Every man will be required to sleep in his own 
hammock, each watch to " lash and carry." In bad weather 
the hammocks of the watch on deck will be kept down on 
the berth-deck under or on their appropriate hooks. No damp 
clothing will ever be stowed in the hammocks or hammock- 
nettings. 

XXIV. All bedding must be shaken and exposed in the rig- 
ging on dry, clear days once a week, if possible. 

XXV. The watch will not be allowed to sleep on deck in 



MEDICAL AND SURGICAL ESSAYS. 107 

rainy weather, nor exposed to dew and currents of air through 
ports and scupper-holes. 

XXVI. The system of steady berth-deck cooks will be dis- 
countenanced. The yeoman, master-at-arms, ship's corporal, 
captain of the hold, writers, nurses, stewards, cooks, servants, 
and all others whose duties confine them below, will be required 
to pass a certain portion of each day in the open air during the 
hours of daylight. Special exercise at great guns, small-arms, 
single-sticks, rowing, and going aloft will be assigned to each 
of them. 

XXVII. Amusements, singing, dancing, gymnastic exercises 
in the rigging, sports on deck, boat-sailing and racing will be 
encouraged. 

XXVIII Vessels will avoid notoriously unhealthy ports,rivers, 
or other localities, unless upon imperative public service, and in 
such places will anchor a sufficient distance from the shore to 
be protected from malarious influences; and all boat excursions, 
hunting parties, or visits of men and officers on shore after 
sunset or before sunrise, or continuance there all night, will be 
strictly forbidden ; and all boat and shore duty involving expos- 
ure to sun and rain will be performed, whenever possible, by 
the natives of the country. 

XXIX. When the general health of a ship's company shall 
be reported by the medical officers as impaired from anchoring 
or cruising in unhealthy localities, the earliest possible opportu- 
nity will be given to recruit, by transferring the vessel to some 
invigorating station, and invalids and convalescents from dis- 
eases induced by climatic influences will be sent to the United 
States without delay. 

XXX. Medical officers are strictly enjoined to exercise an 
unceasing vigilance over the sanitary condition of the vessels 
of the Xavy and of the officers and men on board them, and to 
this end to inquire diligently and report to commanding offi- 
cers, or to the Department, everything conducive to, or militat- 
ing against, the health, comfort, and efficiency of each ship's 
company. 

SANITARY REGULATIONS FOR TRANSPOKTS. 

The causes that operate to make men-of-war unhealthy exist 
in greater force on board of vessels engaged in transporting 
troops. There is a greater accumulation of filth from the evacu- 
ation of the contents of the stomach by the sea-sick and of faeces 



108 . MEDICAL AND SURGICAL ESSAYS. 

and urine by those too lazy or unable to go to the water-closets ; 
there is a more considerable impoverishment of air by the over- 
crowding of men ; and the depressing influences of discontent, 
disappointment, and home-sickness, operate to a more powerful 
degree upon the soldier than the sailor. The steamers that 
carried three-months' volunteers to Annapolis in April, 1861, 
arrived, after only three days' passage from New York, in the 
most filthy condition imaginable, and, had the weather been 
hotter, or the passage a few hours longer, three-fourths of the 
troops would certainly have been disabled. As the military 
surgeons who accompany transports are frequently unused to 
the special exigencies of ship life, their labors will, probably, be 
somewhat facilitated by the following suggestions : 

I. A spacious, convenient, light, well-ventilated part of the 
vessel should be selected for a sick-bay or hospital, which 
should be under the special care of the hospital steward and 
nurses, and whither all invalids, excepting trifling cases able to 
go on deck, should be transferred as soon as reported ill. 

II. Besides the regular attendants upon the sick, two or 
three men, not subject to sea-sickness, should be detailed from 
each company to act as a sanitary police, who are to be under 
the immediate control of the medical officers. They should be 
divided into three watches and be kept alternately on duty, 
both night and day, in the ordinary succession of sea -watches. 
They should be required to patrol the sleeping quarters of the 
men, and be constantly on the alert to prevent any act of un- 
cleanliness. Sea-sick men who vomit or discharge their urine 
and excrement on the deck or in their bunks, should be imme- 
diately removed to the spar-deck, and the excreted matters at 
once cleared away. The sea-sick should be compelled to remain 
on deck all the time and be placed on matti'esses, if too ill to 
sit up. Compulsory exercise by being walked between two men 
and the compulsory ingestion of hot soup will hasten their 
recovery. 

III. All hands should be called at daylight, and be compelled 
to make up their beds neatly, rolling back the upper blanket to 
expose the interior, and then go on deck. The bunks should be 
carefully inspected every morning, and all wet blankets and 
clothing sent on deck to be dried on clothes-lines. 

IV. Clothing and accouterments should be kept in places 
assigned them, and not be allowed to encumber the bunks. A 
certain hour should be appointed for changing under-clothing, 



MEDICAL AND SURGICAL ESSAYS. 109 

and access denied. to it at all other times, except in special 
eases. 

V. The men should be kept on deck all day when possible, 
but never be allowed to lie down or sleep on a wet deck. 
Awnings should be spread forward and aft in hot or rainy 
weather, and the men should be further protected from rain by 
overcoats, which should never be placed in their bunks, but be 
hung up on the bunk-posts, or in a place appointed. 

VI. All air-ports should be kept open whenever possible, 
and wind-sails should be set all the time and pointed to 
every change of wind. In rainy weather tubs should be placed 
under them to collect the water. Every transport should be 
outfitted with ventilators, operated by hand or machinery. 

VII. If the troops remain more than a few days on board, 
their bedding should be exposed to the sun and air at least 
once a week. 

VIII. The men should be required to wash their bodies every 
morning, stripping perfectly nude when the weather will per- 
mit. If the transport cannot supply condensed steam* for the 
purpose, salt-water soap should be provided for the ablution of 
the body and for washing clothes. 

IX. If the berth-decks are kept perfectly clean they will not 
require to be washed oftener than once a week, and this should 
be done only in dry weather and with hot water, which should 
be removed as rapidly as possible by swabs, squillgees, drying- 
stoves, &c. The beams, bulk-heads, and bunk-posts should be 
whitewashed at the same time. 

X. Hot coffee and biscuit should be allowed on turning out. 
Breakfast at 7 a. m. ; dinner at noon, and supper at 6 p. m. ; 
and all meals should be eaten on deck, except in very in- 
clement weather. 

XI. The men should be occupied with their proper military 
exercises as much as possible, as well as be obliged to assist in 
working ship, hoisting ashes, getting up anchor, &c. 



RESECTION OF HEAD OF FEMUR FOR GUNSHOT WOUND. 



By W. E. Taylor, Surgeon United States Navy. 



Naval Hospital, Mare Island, Cal., 

July 12, 1870. 

Name. — Charles B. Scott. 

Grade. — Seaman. 

Native of — Ireland, age, 34 years. 

Shipped at — San Francisco, May 17, 1869. 

Admitted from United States Steamer Mohican. July 12, 1870. 

Diagnosis by hospital ticket. — Gunshot wound. 

FRED. E. POTTER, 

Surgeon United States Navy. 

Hospital ticket states : Time and place of occurrence, Teaca- 
pan Eiver, west coast of Mexico, June 17, 1870. Origin : There 
is positive evidence that it was in the line of duty, the facts 
being as follows, viz : 

Was wounded during an attack upon a piratical vessel, in Teacapan River, 
west coast of Mexico, June 17, 1870; the hall entering the left nates, mid- 
way between great trochanter of left femur and point of coccyx; have been 
uuable to discover its exact locality ; discharge, scanty ; general health, fair; 
treatment, water-dressing, and anodynes when required. 

On admission, general condition of the patient is decidedly 
below par ; appetite is poor ; does not sleep well, and complains 
of a great deal of pain in the left hip-joint, upon the least mo- 
tion. In consequence of the long sea-voyage, (eleven days,) 
and his having been moved about so much, it is not considered 
advisable to make an examination of the injury until he shall 
have become somewhat rested. To have full diet and milk, 
and snlph. morphia at night. 

VMh. — Took gr.ss. sulph. morphise last night, but did not rest 
well. 

liih. — Rested well last night without any morphia, and feels 
more refreshed to-day. An examination of the wound was 
made, with the following results, viz : Patient is unable to lie 
upon his back, but lies upon his right side, with the injured 
limb semi-flexed, and resting upon the right leg; the whole 
limb is inverted and rotated inward. On account of this posi- 



MEDICAL AND SURGICAL ESSAYS. Ill 

• 

tion, it is difficult to get an accurate measurement of the injured 
limb, but, as far as can be ascertained, it seems to be about one 
inch shorter than its fellow. The motion is very limited, but, 
with some pain and difficulty, the left leg and thigh can be 
moved a short distance outward. The wound of entrance is 
small, and situate a little below the top of the great trochanter, 
and about two inches posterior to it. The discharge from it is 
scanty, sanious, and fetid. Examination with a probe shows 
that the ball, after entering at the above-mentioned point, 
passed inward, forward, and a little upward. The instrument 
readily passed for some distance in this direction, which led 
directly toward the neck and head of the bone. After passing 
between two and three inches, the point of the probe was ar- 
rested against a rough solid body, and then seemed to pass on 
in a cavity lined with bone, for a short distance, when it became 
finally arrested. From this it would seem that the neck; of the 
femur had been pretty extensively fractured, and probably the 
head also. Nothing was felt that was thought to be the ball. 
The porcelain-pointed probe was also used, but failed to show 
any lead-marks. Probe was much discolored. The ball is 
probably lodged in the head or cotyloid cavity. 

From the length of time which has elapsed since the injury, 
it is likely that more or less callus has formed, and this, to- 
gether with the awkward position of the limb, made the exam- 
ination somewhat unsatisfactory. The examination was made 
without using any anaesthetic. The joint is not much swollen, 
but is very tender to the touch. The patient is in a much bet- 
ter condition than could be expected after such a serious wound ; 
his appetite is improving; he has no hectic, and sleeps toler- 
ably well ; bowels regular. 

R. — Quiniie sulph., 3i- 
Ferri chlor. tinet., ^i. 
Glycerine, |iij. 
Ft. sol.— S. Teaspoouful three times a day ; to have full diet, milk and 
ale, and sulph. morphia- at night, as required. 

Wound to be dressed with oakum. Under the circumstances, 
some operation will doubtless be required, and it is desirable to 
get the patient in as good a condition as possible. 

July 25th.— Patient has not improved as much as was antici- 
pated, notwithstanding rest, nutritious diet, &c. He complains 
of constant pain in the limb, which he is unable to move or allow 
to be moved; and as he seems to be slowly failing, and there 



112 MEDICAL AND SURGICAL ESSAYS. 

being evidently no prospect of recovery if treated on the ex- 
pectant plan, the operation of excision of the injured parts was 
decided upon as giving him the best chance for life, especially 
as there was no injury to the huge vessels and nerves and very 
"little damage to the soft parts. The nature of the case, the 
chances of life, and the risks of the operation having been fully 
explained to the patient, he cheerfully consented to submit to 
any operation that might be considered necessary. Accord- 
ingly it was determined to perform the operation to-day. The 
following-named medical gentlemen were present, viz: Surgeon 
John M. Browne, Assistant Surgeons J. A. Hawke and A. M. 
Owen, United States Navy, and Drs. Weed and Vallijo, of 
Vallejo, California. At 11 o'clock a. m. the patient was placed 
thoroughly under the influence of chloroform by Assistant 
Surgeon A. M. Owen. The limb was brought to the straight 
position. This was easily accomplished, and during the move- 
ment well-marked crepitus was elicited. A straight incision 
was then made, commencing about two inches above the great 
trochanter, and carried downward over its center and along the 
outer side of the thigh for about eight inches. This incision 
was carried deeply, and the joint readily exposed and opened. 
The finger being then carried into the joint, it was found that 
the neck of the femur was broken entirely across, and numerous 
fragments of bone could be felt in the cavity. The thigh was 
then well adducted and pushed upward in order to render the 
trochanter prominent. The muscular attachments were then 
carefully divided close to the bone, which, being well cleared, 
was pushed through the wound and sawn off just below the 
trochanter minor, with an ordinary amputating saw; after 
which the fragments of the neck and head were removed with 
the fingers and forceps. The removal of these fragments, some 
twelve in number, was easily accomplished. The ball, a conoidal 
one, weighing 240 grains, and very much battered, was also 
removed along with the fragments of the head, where it had 
lodged after causing the fracture. The capsular ligament was 
pretty thoroughly removed. ( No new bone had been formed. 
The wound of entrance was not interfered with, as it was so far 
removed from the line of incision. Very little blood was lost — 
about four ounces. Two small arteries required securing. The 
entire wound was thoroughly syringed with a weak solution of 
permanganate of potassa in order to destroy fetor and remove 
clots of blood and osseous fragments. After the-bleeding had 



MEDICAL AND SURGICAL ESSAYS. 113 

ceased, the wound was partially approximated by four sutures, 
about two inches of the central portion being left open for 
drainage. Patient was placed in bed, with the limb secured in 
the straight position in an ordinary fracture-box, and the wound 
dressed with oakum. The patient bore the operation very well, 
and promptly rallied from the effects of the chloroform, soon 
after which he took gr. ss. sulph. morphia 1 in §ij of whisky, to 
be followed by beef essence ; the morphia to be repeated at 3 
o'clock p. m. 

Upon examination of the injured bone after its removal it was 
found that the ball had struck the head of the bone at its junc- 
tion with the neck, breaking the latter into three pieces, the 
line of fracture being oblique, and extending into and involving 
the head. The head of the bone was also extensively commi- 
nuted, seven pieces being removed. In all, eleven good-sized 
pieces were removed, exclusive of the upper portion of the 
shaft. The ball had lodged nearly in the center of the head. 
When mounted, the specimen showed quite a large opening at 
the point of entrance of the ball, for which no piece of bone 
could be found, this loss of substance being probably due to 
this portion being pulverized by the ball, and some having 
escaped with the discharge prior to the operation, and the 
remainder being washed out afterward. Almost all of the 
articular cartilage had been removed, and the remainder was 
much eroded by the action of the pus. The round ligament 
was uninjured, and w r as attached to one of the pieces of the 
head. According to the statement of the patient and others 
present at the time of the reception of the wound, the weapon 
was fired at a distance of about eighty yards, the patient being 
at the time in one of the cutters ; and he was stooping when 
struck. 

9 o' 'clock p. m. — Patient has no pain, but is very nervous and 
restless. Pulse 150 per minute. To have gr. ss. sulph. morphia?, 
and repeat 12 o'clock. Beef essence, milk and whisky as re- 
quired. 

26th, 9 o'clock a. m. — Did not sleep well last night. Free from 
pain. Still quite nervous. Pulse 120. Tongue coated. Com- 
plains of want of sleep. Wound looks well, and is discharging 
bloody serum. 

%. — Quiniae sulphat., grs. ij. 

S. Thrice daily. General diet to consist of beef essence and milk, witli 
stimulants as required. 
8 M 



114 MEDICAL AND SURGICAL ESSAYS. 

9 o'clock p. m.— Condition unchanged. Vomited freely during 
. the afternoon. Attributed to too much milk. 

2,1th, a. m. — Took gr. i. morphia? sulphat. during the night, and 
rested pretty well, and is more composed this morning. Had beef 
essence and one egg for breakfast. No pain. Pulse still fre- 
quent, 120, and irritable. Wound looks well, and is somewhat 
swollen and tender. Discharge more purulent and offensive. 
In consequence of the bedclothes becoming soiled and offensive 
the patient was carefully moved from his bed, and clean sheets, 
&c, substituted for those soiled, and when replaced in bed he 
was turned toward the right side in order to afford better 
access to the wound. Wound was dressed with oakum, moist- 
ened with sol. potassse permanganat. 

28t}i, a. m. — Patient was quite restless during yesterday after- 
noon. Took during the night gr. iss. morphiae sulphat., and 
rested pretty well, and this morniug is more comfortable, and not 
quite so nervous. For breakfast had beef essence and milk toast. 
Wound discharging moderately ; discharge is more purulent, 
and not so offensive. He complains a good deal of excoriation 
of the skin about his hips and back, caused by contact with 
the discharge, together with free perspiration from the com- 
bined effects of debility and warm weather. There is also a 
small bed-sore on the right hip. The sores are dressed with 
ung. ox. zinc, and protected as well as possible with cotton bat- 
ting, which is to be frequently changed. The wound is dressed 
twice daily, and at each dressing all the soiled articles are 
taken away and the pus removed by gentle pressure, the wound 
thoroughly sponged with slo. permang. potass, and dressed with 
oakum. To have Sherry wine instead of whisky, and grs. iij. 
sulph. quinia? thrice daily. General diet continued. 

29th. — Patient was very nervous and restless all the after- 
noon of yesterday, and toward evening became delirious, 
which continued until 9 o'clock, pulse being 130, and irritable. 
As he suffered no pain, and insomnia seemed to be the princi- 
pal trouble, it was determined to give hydrate of chloral in- 
stead of morphia. Accordingly, at 9 o'clock, grs. xxx. of chlo- 
ral were given in solution, with directions to repeat in one hour 
if necessary. In a few minutes he went to sleep, and when I 
visited him at 11 o'clock he was still sleeping quietly, and did 
not awake until 2 o'clock, after which he slept more or less 
until morning. Only, one dose was given. This morning he 
feels much refreshed, looks more natural, and fe'els better than 



3IED1CAL AND SURGICAL ESSAYS. 115 

at any time since tlie accident. Pulse is 100, and pretty good. 
Wound looks well, and discharges laudable pus. Dress as 
usual. Treatment and diet continued. The good effect of the 
chloral was very marked ; it seemed to fulfill the indication, and 
produced refreshing sleep. 

30th. — Look grs. xxx. of chloral at 9 o'clock last night, and 
grs. xx. at 12 o'clock' and slept until 7 o'clock this morning, get- 
ting something like nine hours' refreshing sleep. Bowels not 
having been opened since 21th instant, §i. ol. ricini -was given 
this morning, which operated quite freely. Appetite is good ; 
pulse 90, and good, and he is not at all nervous. Wound is dis- 
charging pus quite freely. Removed him from bed to-day, and 
changed sheets, &c. Dress wouud as usual, and repeat chloral 
at night. 

31st. — At 10 o'clocklast night took grs. xx. of chloral, which was 
followed by vomiting ; at 12 o'clock grs. x., after which he slept 
more or less until morning. He is quiet and cheerful, has no 
pain, pulse 96 and fair, tongue clean, and skin in a better con- 
dition, although he still perspires a good deal and complains of 
more or less discomfort from the excoriations on his back. 
Wound is discharging a moderate amount of laudable pus. All 
the nervous symptoms have gone, and altogether his general 
condition is very favorable. He spends a portion of his time in 
reading. Sutures were removed to-day, and there is partial 
union of the wound. Adhesive straps were applied, and the 
oakum dressing continued. 

August 1st. — Patient became restless toward evening of yes- 
terday. Took grs. xxx. of chloral, but did not rest well. 

2<1. — Restless condition returned last night. Took grs. xx. of 
chloral at 9 o'clock and grs. xx. at In o'clock, after which he 
slept well, and this morning is more cheerful, and says he feels 
better than at any time since the operation. Appetite good, 
tongue cleau, pulse 90. Removed from bed to-day, and sheets 
changed. Wouud discharging very freely. Continue, and to 
have 3ij cod liver oil thrice daily. 

3d. Took grs. xi. of chloral last night, and slept well. Condi- 
tion about the same as yesterday. Increase quinine to grs. iv. 
thrice daily, with gtts. xv. acid, sulpb. aroni. To have beef- 
steak or mutton-chop for breakfast and dinner. 

4th. — Took grs. xi. of chloral last night in two doses, and slept 
several hours. Still improving. Dress wound as usual. 

oth. — Took ouly grs. xxx. chloral last night, aud slept several 



116 MEDICAL AND SURGICAL ESSAYS. 

hours. Bowels moved twice to-day naturally. Appetite good 
and tongue clean. Wound discharging very freely to-day. 
Patient complains of feeling very weak, but there is nothing to 
indicate any failing. Continue diet, and increase cod-liver oil 
to | ss twice a day. 

6th. — Took grs. xxx. of chloral, but did not rest well. 

7th. — Patient was very nervous last night, and for a time 
partially delirious ; he complained of feeling very drowsy, and 
was constantly yawning, but could not sleep. The chloral, in 
its usual dose, seems to have lost some of its effect, and, instead 
of increasing the dose, I determined to' combine morphia with 
it, and at 9.30 p. m. gave him grs. xxx. of chloral, and gr. i mor- 
phia at 3 o'clock. He then slept very well, and is quite cheer- 
ful this morning. Wound dressed as usual. During the dress- 
ing, pus, mixed with florid blood, was quite freely discharged, 
the blood coming probably from the tender granulations. Con- 
tinue all treatment. 

8th. — Doing very well, and says he feels "first rate." ,Took 
grs. xxx. chloral and gr. \ morphia, and slept well. Wound 
dressed as usual, discharge moderate, and tinged with blood. 
He was removed from bed to-day, and the bedclothes changed. 
After being replaced in bed, some extension on the limb was 
made, but was not well borne. Is gaining in flesh, as indicated 
by his face. 

9th. — Took chloral and morphia last night, and slept well. 
Appetite good, and bowels regular. Discharge from the wound 
is small in quantity and laudable. 

10th. — Doing well in all respects. Took chloral and morphia 
as usual last night. 

11th. — Slept well last night without any medicine, and feels 
very comfortable to-day. Appetite good. Pulse 90, and good. 
Wound all healed, except about one inch of the central portion, 
and a small opening at the lower end. Discharging a small 
quantity of laudable pus. 

R. — QniniiB sulph. 3ii. 
Acid sulph. arom., 3 ii- 

Aquie, ^iv. 
Ft. sol. — S. Teaspoonful ter. die. Substitute ale for Sherry wiue, and con- 
tinue cod-liver oil and nutritions diet. 

lUh. — Since the 11th patient has done well. Sleeps some 
naturally, but takes regularly grs. xx. chloral and gr. £ sulph. 
morphia at night, which always insures several hours of good 



MEDICAL AND SURGICAL ESSAYS. 117 

sleep. Bowels regular. Pulse 90, and good. Wound healed, 
except the central portion. Discharge moderate and healthy. 
Appetite excellent; is gaining in flesh. Bedclothes changed 
to-day. Continued. 

nth. — Doing well ; had slight fever during afternoon of 15th 
instant, which lasted a short time, and passed of with mode- 
rate perspiration. This febrile movement seemed to have been 
caused by excitement on account of the death of one of the 
patients in the same ward. Skin is much more healthy in its 
action, and he does not perspire so much. 

21st. — Improving. Wound discharges about %\i. pus daily. 
Appetite excellent ; takes soup, beef-tea, steak, mutton-chop, 
and fruit, chloral and morphia at night. Increase cod-liver oil 
to fss. thrice daily. He was removed from bed to-day, and the 
limb taken out of the fracture-box, and, all plaster and band- 
ages being removed, the whole limb was thoroughly bathed 
with warm water and soap, and then well rubbed with soap 
liniment ; adhesive strips were then re-applied, the limb re-placed 
in the fracture-box, and counter-extension being made by means 
of the ordinary perineal baud, extension was made by turning 
the screw. This is to be gradually increased, by means of the 
screw. 

20th. — Appetite has failed somewhat during the past few days, 
tongue coated, bad taste in the mouth, and he complains of a 
sense of weight and discomfort in the epigastrium. Wound 
doing well, but the inguinal glands are enlarged and tender, 
and between them and the wound the skin is red and hot. 
Excoriations nearly healed. Discontinue extension and counter- 
extension, and patient is allowed to lie upon the right side for 
several hours, the limb remaining in the box, which is turned 
inwards. Omit cod-liver oil and quinine. 

I);. — Blue mass, grs. vi. 

Ext. colo. comp., grs. iv. 
Ft. pil. No. iij.— S. At 9 o'clock p. m., anil ^ss. ol. ricini in morning. Apply 
tinct. iodine to inflamed skin. 

28tJi. — Bowels have been freely opened, and patient is much 
better in all respects. Appetite returning, tongue clean, and 
the inguinal trouble much improved. He is very cheerful. 
Bedclothes changed to-day. Hip is much more solid, and 
bears handling very well. He is able to move the foot and leg. 
The limb was taken out of the fracture-box to-day, and the 
adhesive plaster removed, and the leg allowed to rest easily on 



118 MEDICAL AND SURGICAL ESSAYS. 

a pillow for several hours. After which it was lightly put up 
in the box, without adhesive plasters, as under the circum- 
stances it is not considered advisable to make auy further 
attempts at exteusion for the present. 

R. — Ferri et qninisB cit., 3iij- 
Glycerine, 
Aqure aa, ^ii. 
Ft. sol. — S. Teaspoonful ter. die., and §ss. cod-liver oil, once a day. 

30th. — Discontinued chloral and morphia last night, as he 
now sleeps well without it. The chloral was first given on 29th 
July, and since then he has used about two ounces; it always 
suited bis case admirably. Vomiting followed its use once, but 
this may have been accidental. 

September 1st. — Improving; wound discharging moderately; 
inguinal trouble gone; bed-sores and excoriations all healed. 
Leg is removed from the box, and slight passive motion com- 
menced, and then the limb is allowed to rest lightly on a pillow 
for several hours, and replaced in the box. Oil-silk removed 
from under the hip to-day, as it has a tendency to keep the 
parts moist. 

4th. — Discharge diminished, and since the 1st instant has 
been thin and serous in its character. While changing his 
bedclothes to-day, he was raised to the erect position for a short 
time,, but soon became faint. Takes 3SS. cod-liver oil twice a 
day. Continue iron, quinine, and diet. 

5th. — Some redness and swelling on the outer side of the 
thigh, just below the wound. 

14th. — On the 7th instant was able for the first time, with 
assistance, to leave his bed, and sit for a short time on a 
chair, the limb being extended and well supported. Since 
then he sits up several hours daily. He is gaining in flesh, 
his face, chest, arms, and legs being much better filled out. 
Wound looks well ; no purulent discharge at all ; the serous 
discharge continues ; its gross appearance closely resembles 
synovia, and it probably comes from remains of the joint 
tissues. .There does not seem to be any disease of the bone. 
Wound is sponged daily with tepid water, and dressed with 
lint. Appetite good, bowels regular. 

18th. — Wound all healed, save two small fistulous openings, 
about one inch apart, from which a small quantity of synovial- 
lookiug fluid can be pressed. The whole limb, from the foot to 
the groin, was enveloped in a roller bandage, and a spica of the 



MEDICAL AND SURGICAL ESSAYS. 119 

left groin being made, the foot was slung by a bandage carried 
around the neck, and thus supported, and with some assistance, 
he walked with crutches the length of the ward, about forty 
feet, sat down for a short time, and then returned. 

22d. — With assistance, he went down stairs to-day, and sat 
for a short time on the porch. Outdoor exercise to be con- 
tinned as much as possible. Discontinued cod-liver oil, iron, 
and quinine. General diet to consist of milk, beef-tea, beef- 
steak, mutton-chop, and fruit as needed. 

26th. — Came down stairs to-day and walked with crutches 
for a short distance, outside of the building. 

27th. — While walking yesterday he, by some means, used the 
limb injudiciously, and, to-day, complains of pain in the thigh 
upon attempting to walk, but has no pain when in bed. To 
remain quiet for the present. 

October Mh.—Stiil complains of pain in the hip when attempt- 
ing to stand or walk. The thigh and leg are cedematous and 
hard, having a brawny feel, particularly along the inner and 
outer sides of the thigh, at the knee, and along the anterior 
portion of the leg. This condition has existed, however, for 
some time. The foot is not swollen, nor has it been so at any 
time. General treatment for the swelling to be daily sponging 
with tepid water and soap, friction with soap liniment, and 
occasional bandaging. 

Gth. — Complains of more or less pain in the hip when walk- 
ing, evidently the swinging about of the leg, for want of proper 
support. The foot is somewhat inverted. To-day a piece of 
stout iron wire was bent and carried like a stirrup, under the 
foot, up along the outer and inner side of the thigh, over the 
groin, and reaching almost to the left nipple. This splint was 
then adapted to the various curves of the limb, and, when so 
fashioned, it was worn outside of the clothes, being held in situ 
by two or three strips of bandage. By this means the whole 
limb was kept quite steady, and he did not complain of any 
pain iii walking. 

10th.— Lower fistulous opening has healed. Takes a moderate 
amount of out-door exercise daily. 

27th. — During the past ten days there has been some bloody 
discharge from the opening, and yesterday the lower fistula, 
which had been healed since the 10th instant, opened and dis- 
charged a small quantity of blood and pus. General condition 



120 MEDICAL AND SURGICAL ESSAYS. 

excellent, unci lie gets along very well on his crutches, the limb 
being steadied by means of the wire splint. 

November 10th. — Steadily improving. Since the 30th ultimo 
the fistulous openings have been occasionally injected with solu- 
tions of nitrate of silver, carbolic acid, acetate of lead, &c, of 
various strengths, in order to bring about healing from the bot- 
tom, but with, apparently, no good effect. The wound has 
been repeatedly examined with a probe ; the instrument passes 
directly into the cotyloid cavity, but no diseased bone has been 
detected. The discharge doubtless comes from the remains of 
the old joint, and from the granulations. 

December 4th. — Has walked regularly every day, and can 
now walk at least half a mile at a time. The wound is dis- 
charging more freely than usual, and in order to give a better 
exit to the pus, and expose the parts well, the two openings 
were united by an incision of about one inch in length ; the 
finger was then passed deeply into the wound, but did not 
detect any diseased bone ; the upper end of the shaft of the 
femur seemed rounded off and well covered ; the whole of the 
sinus had a velvet-like feel, and passed in the direction of the 
cotyloid cavity, but owing to the small size of the sinus, the 
finger could not be passed quite that far, and the examination 
was completed with a probe ; the instrument rested on the 
bone, which seemed well covered. The sinus is funnel-shaped, 
the neck being toward the acetabulum. 

21th. — To-day patient went per steamer to San Francisco in 
order to have a plaster cast taken of the pelvis, thigh, and leg, 
with a view of having made a suitable apparatus for the pur- 
pose of strengthening and supporting the hip, and increasing 
the length of the limb. He returned in the evening, having 
borne the trip, a distance of more than fifty miles, very well. 

January 1, 1871. — Doing well; the oedematous condition of 
the thigh and leg has entirely disappeared, and the limb is 
quite natural in appearance, save, of course, the shortening 
and some atrophy of the muscles from long disuse. Patient has 
discarded the wire splint, as the limb is now sufficiently firm to 
retain its position when he is walking on crutches. 

20th. — The apparatus arrived to day ; it consists of Bouvier's 
splint, of sole-leather, as used for coxalgia, with the addition 
of one external lateral steel splint or brace, jointed at the knee 
and ankle, where it is attached to a shoe, with a thick cork sole, 
in order to increase the length of the limb, but leaving it one- 



MEDICAL AND SURGICAL ESSAYS. 121 

half inch shorter than its fellow, this difference in length beiug 
considered necessary to avoid tripping in walking, which might 
otherwise happen, in consequence of impaired use of the knee 
and hip. The steel splint is so arranged that it can be entirely 
detached from the thigh-splint and shoe. This was so arranged 
upon the supposition that in the course of time he could walk 
well enough without the splint, by using only the leather por- 
tion of the apparatus and the shoe. The steel splint gives some 
increased support, but its main object is to correct and over- 
come the tendency to inversion of the limb. It fitted very well, 
but at first felt very awkward. The apparatus was substan- 
tially and elegantly made by Messrs. J. H. A. Folkers & Bro., 
instrument makers and dealers, San Francisco, and cost, com- 
plete, $148 currency. 

21s/. For two or three days past there have been slight swell- 
ing and redness in the cicatrix, left by the bullet, and to-day 
this opened and discharged a small quantity of pus; it had 
been healed for about five months. A probe being passed into 
this opening, went as far as the acetabulum, and came in con- 
tact with one passed in the wouud left by the operation. 

30th. — Today Scott went to Vallejo and was photographed, 
both with and without the apparatus. 

February Int. — Patient is this day transferred to the naval 
hospital at this station, in charge of Surgeon John M. Browne, 
United States Navy, the transfer being made on account of 
the new hospital being ready for the reception of patients. 
When transferred, his general condition is about as follows, viz: 
General health excellent, he being, perhaps, the healthiest-look- 
ing of all the patients; appetite good, sleeps well, and has not 
taken any medicine, save an occasional laxative, for four 
months. The left buttock is somewhat flattened ; there is a 
small opening about the center of the line of incision, which 
discharges a small quantity of pus. The bullet-wound yet re- 
mains open, but shows a tendency to heal. The upper end of 
the shaft of the femur rests on the innominate bone, about on a 
level with the lower margin of the acetabulum, and the limb is 
about three and one-half inches shorter than its fellow. The 
hip is very firm and strong, and the whole weight of the body 
can be borne upon it. The knee is yet quite stiff, but is slowly 
improving ; the foot is slightly inverted, but not so much so as 
prior to using the apparatus. 

He has very good use of the limb, and can move it freely 



122 MEDICAL AND SURGICAL ESSAYS. 

backward and forward and outward, and far enough inward to 
carry it across the other leg. He is becoming more accustomed 
to the apparatus, and there is no doubt but that in time he will 
be able to walk quite well with it without the aid of crutches. 
At ho time have any abscesses formed in the limb. He has 
gained about thirty pounds since the operation of excision. 

W. E. TAYLOE, 
Burgeon United States Navy. 

REMARKS. 

This report terminates my official connection with the case; 
and inasmuch as the result cannot yet be positively known, it 
would, perhaps, be premature to make any comments or draw 
any conclusions. There is one point, however, worthy of men- 
tion, viz : That prior to the operation the patient complained of 
severe and constant pain, which ceased immediately upon the 
removal of the injured parts. This relief was so marked, that 
even had the case terminated fatally, I think operative inter- 
ference was warranted, with a view to euthanasia. 

It will also be noticed that treatment by extension and 
counter-extension was abandoned after a trial of a few days, 
and I feel quite certain that this particular case did better 
without it. 

The case was admirably suited for the operation of excision ; 
a better one could not well have been selected. 

There was no injury to the vessels or nerves, and none to the 
soft parts, save the small wound of entrance ; the pelvic walls 
were not injured. There were no abscesses, and but little swell- 
ing about the joint. The neck and head of the femur alone 
bore the brunt of the injury. 

W. E. TAYLOE, 
Surgeon United States Wavy. 



REMARKABLE COURSE OF THE BULLET IN A CASE OF GUNSHOT 
WOUND OF THE ABDOMEN. 



By Albert L. Gihox, A. M., M. D., 
Surgeon U. S. Navy, United States Hospital Ship Idaho, Nagasaki, Japan. 



At 4 o'clock of the afternoon of January 30, 18G9, we were 
called in baste to the English steamship United Service, which 
had just arrived, to see the pantry-boy, Men Sing, a Chinaman, 
about thirty years of age, with a gunshot wound of the abdomen, 
received thirty hours before while at sea, and occasioned by 
the accidental discharge of a Smith & Wesson's revolver. The 
pistol was kept in a closet near the pantry, and was found still 
in its place, hanging muzzle downward, the barrel being de- 
tached from the cylinder and turned partly back, as though the 
injured man had been investigating the mechanism of the 
spring which secures the barrel, when the charge was exploded. 
There being no surgeon on board the vessel, the patient had 
been placed in his bunk, in a dark, ill-ventilated apartment. 
Two doses of castor oil had been administered, (of which the 
first only was retained,) and wet dressings applied to the wound. 

Assistant Surgeon J. H. Kidder visited him at once, and 
found that the bullet had scored the palmar surface of the tip 
of the third finger of the right hand and outer margin of the 
palm of the same, both wounds being scorched and blackened; 
and that half an inch below and two inches to the right of the 
umbilicus there was a penetrating wound directed obliquely 
downward toward the left groin. There was no orifice of exit 
nor other injury. Apparently the man had been holding the 
pistol by the barrel with his right hand and trying to detach 
the cylinder with his left, the muzzle pointing inward toward 
his abdomen, when he raised the hammer and let it fall, thus 
discharging the load. The wound had closed and nearly 
cicatrized, rendering it impossible to detect the track of the 
ball, which was not indicated by any line of tenderness, tume- 
faction, nor discoloration. There were swelling and complaint 
of pain on pressure in the left groin, extending into the scrotum 
on that side, but not excessive. x\. most careful examination, 



124 MEDICAL AND SURGICAL ESSAYS. 

which was repeated by myself about two hours later, with the 
same result, failed to determine the site of the ballet, but a 
gurgling of mingled air and fluid, similar to that afforded by a 
congenital inguinal hernia, could be distinctly felt directly in 
the supposed track of the ball, along the upper part of the 
left spermatic cord, and the possibility of such a condition of 
parts was suggested to me by Dr. Kidder as soon as I saw the 
case. There was dorsal decubitus, but no sign whatever of 
peritonitis; the knees were not drawn up, and the thighs could 
be flexed and extended without occasioning pain. The tongue 
was moist and yellow ; the pulse small, soft, and frequent. As 
the oil already administered had failed to operate, and the 
peristaltic motion induced thereby was quite painful, Dr. Kidder 
at once directed a simple enema, and ordered cold applications 
to the lower part of the abdomen. At 7 o'clock the enema 
brought away two large fecal stools, free from blood, but con- 
taining a greater quantity of mucus than is usual. The patient 
was then given a full dose of opium and left for the night — his 
mind clear ; suffering no great pain ; his pulse fuller and slower 
since his stools ; his tongue moist and surface cool. 

He continued very much in this state, Dr. Kidder and my- 
self visiting him daily, until February 4th, when the tumidity 
of the groin and left side of the scrotum had increased and 
become dark-colored and very sensitive under pressure, which 
produced a crackling, gurgling noise, confirming the suspicion 
of a hernia wounded by the ball. Under the impression that 
the bullet must have lodged in this vicinity, I made a deep in- 
cision into the groin, and the following evening the distension 
of the scrotum was so great that I punctured it in numerous 
places, discharging a quantity of fetid gas. During all this 
time there was inconsiderable febrile reaction ; the pulse con- 
tinued soft though frequent, and the tongue moist; there was 
no vomiting nor retching, nor any tenderness nor inflation of 
the abdomen, except in the left inguinal region. Occasional 
enemata were administered, producing fecal stools, which were 
never bloody. His urine was scanty and high-colored, but 
"voided regularly. Opium was administered in full doses; he 
was sustained by beef-essence and milk-punch; and cold dress- 
ings were kept applied to the groin and genitals. 

The steamship having received orders to leave the port, it be- 
came necessary to remove the patient on shore, and he accord- 
ingly passed out of our hands into'the hospital of the Japanese 



MEDICAL AND SURGICAL ESSAYS. 125 

government at Nagasaki, under the superintendence of Dr. C. 
G. Van Mansvelt, who, in consultation with us on the Sth, at 
once suggested that a congenital hernia had been wounded, 
confirming our own view of the ease, and continued the course 
of treatment, though increasing very much the frequency of the 
opiate administration, and substituting milk for beef essence 
and punch. The tumefaction was less than when we had last 
seen him two days before ; but the scrotum and groin were 
much discolored, aud fecal discharges were taking place from 
the incision in the groin, and from one of the punctures in the 
scrotum. 

On the 14th I received a note from Dr. Mansvelt, informing 
me of the death of the patient, and requesting Dr. Kidder and 
myself to assist at a post-mortem examination. The previous 
day Dr. M. had cut off several inches of sloughing intestine, 
which protruded from the bottom of the scrotum. On laying 
open what we supposed to have been the course of the ball, we 
were surprised to find no trace of it, and discovered, on further 
dissection, that it had passed transversely and somewhat supe- 
riorly across the abdomen to the left hypochondrium, near the 
extremities of the floating ribs, whence it was deflected down in 
a curvilinear direction toward the left groin, crossing, though 
much more deeply, the incision which I had made on the 4th 
instant, and losing itself in the general destruction of tissue in 
this region. Subsequently, after we had sawed out the ante- 
rior wall of the pelvis, with the bladder and genitals intact, we 
found that the bullet had crossed behind the symphysis to the 
right side, and was lodged behind and rather below the supe- 
rior ramus of the pubis, where it was completely concealed from 
external observation, and where it had imbedded itself without 
exciting the slightest irritation. As supposed, a congenital 
hernia of the left side had been wounded, and a large extent of 
small intestine destroyed by sloughing. The peritoneum was 
everywhere adherent, and numerous abscesses existed between 
its several folds. The liver was enlarged and softened, the gall- 
bladder enormously distended, and the mucous membrane of 
both large and small intestines deeply ulcerated. The patient 
was very much emaciated ; he had been an inveterate opium- 
smoker, and, like many of his race, had suffered from chronic 
diarrhcea. 



COMMINUTED, DEPRESSED, AND IMPACTED FRACTURE OP THE SKULL; 
TREPHINING SIXTY HOURS AFTER THE INJURY; RECOVERY. 



By Albert L. Gihox, A. M., M. D., 
Surgeon U. S. Navy, United States Hospital. Ship Idaho, Nagasaki, Japan. 



On the evening of February 6, 1869, Hermann H. Johann- 
sen, a native of Holstein, seventeen years of age, while furling 
the upper foretop sail of the American brigantine Spray, was 
jerked forward of the yard, it is supposed by the bellying out 
of the sail from the mate having let go the buntlines, and fell 
headforemost from a height of about sixty feet, striking the 
deck, and fracturing the skull on the left side over the parietal 
and temporal bones. He was picked up in a state of uncon- 
sciousness and carried into the cabin, where he lay on the bare 
deck, almost without attention, until late in the afternoon of 
the 8th, when the vessel arrived at Nagasaki, and he was seen 
first by Dr. J. H. Kidder, assistant surgeon United StateslSTavy, 
and subsequently by myself. We found him comatose ; his res- 
piration retarded and noisy, with occasional puffing of the 
lips ; his pulse slow and full, but regular ; his surface 
cool; his pupils dilated and insensible; the left parietal 
bone broken into fragments, some of which were movable 
under slight pressure, and others deeply depressed; severe con- 
tusion and tumefaction of the scalp and extensive ecchymosis 
of the lids of the left eye and vicinity of the left ear, though 
there was no evidence of there having been bloody or serous 
discharge from the ear, mouth, or nostrils. 

It being impossible to operate satisfactorily upon him, or to 
have him properly cared for afterward in the small, ill-venti- 
lated apartment he was then occupying, wet cloths were applied 
. to the head, which was elevated, and watchers placed by him 
to prevent his tendency to roll over on the injured side ; and 
early on the morning of the 9th lie was removed to the hospital 
on board the Idaho, and at once prepared for operation. The 
coma was more profound than on the previous evening, but his 
condition in other respects was unchanged. 



MEDICAL AND SURGICAL ESSAYS. 127 

A large rectangular flap was reflected from the mesial line 
toward the left ear and eye, exposing the site of fracture, which 
was found to involve the larger portion of the parietal bone, and 
was much comminuted. The greatest depression was just pos- 
terior to the eminence, whence several long fissures extended 
toward the frontal, the extremity of the greater wing of the 
sphenoid and the lambdoid suture, through the parietal and 
squamous temporal bones. The edge of the depressed portion 
was forced so far beneath the neighboring bone that an elevator 
could not be used, and I applied an inch-trephine on the occip- 
ital side of the fracture ; but even after removing the circlet of 
bone, neither Dr. Kidder (who ably assisted throughout the 
operation, and to whose judicious care of the patient the suc- 
cess of the case was in great part due) nor myself were able to 
elevate the depressed fragment ; and I accordingly removed, by 
Hey's saw, a triangle of bone one inch in length, and three- 
fourths of an inch in width at the base, the beveled edge of which 
was tightly impacted in the diploe of the opposite side. The 
remaining fragments, the larger of which were entirely isolated, 
were then lifted into place, and a broad coagulum, which was 
spread out between the dura-mater and the skull, was removed 
as thoroughly as possible. The inner table was badly splintered, 
and considerable hemorrhage attended the operation, which 
lasted an hour and ten minutes. When all bleeding had spon 
taneously ceased, the flap was laid back in its place and cov- 
ered with a compress of wet lint, kept in position by a six-tailed 
bandage ; neither sutures nor adhesive straps were used in the 
dressings. 

February 10th. — The patient still comatose ; pulse accelerated, 
but no heat of skin ; small quantities of beef-essence and milk- 
punch were placed in the mouth on alternate half hours, and 
readily swallowed. 

11th. — Beginning to manifest signs of returning conscious- 
ness ; pupils contracting ; breathing quiet and more frequent. 

12th. — Still unconscious. Toward evening the pulse became 
rapid, the skin hot, and the face flushed ; was so restless that 
two attendants could scarcely retain him in bed. Kept the 
head constantly wetted with cold water; sponged off the whole 
surface of the body every hour, and opened the bowels by 
enema. 

13th. — Opened his eyes and followed a caudle moved before 
them, but takes no notice when addressed. Continually tossing 



12S MEDICAL AND SURGICAL ESSAYS. 

about in bed, and endeavoring to put his hand on the site of 
injury. 

loth. — Regards his attendants with a vacant stare; is attracted 
by lights and heeds loud noises, but gives no evidence of un- 
derstanding what is said to him, and makes no attempt to 
articulate. Swallowed a soft-boiled egg. 

16th. — The head becoming offensive, 'removed the dressings, 
which had not been disturbed since the operation, and found 
the wound in the scalp open in its whole extent, and exuding a 
dark-colored, non-laudable pus. Applied strips of isinglass 
plaster and covered the wound with dry greased lint. Ordered 
ten minims of tinct. ferri chlorid. every three hours, and con- 
tinued frequent administration of small quantities of beef- 
essence and milk-punch. Opened the bowels by confection of 
senna. 

18th. — Shows signs of awakening intelligence, and, on the fol- 
lowing day, spoke for the first time, replying feebly in the mon- 
osyllables, "ja" and "neiu," when addressed. Eenewed com- 
presses daily. 

25th, — Smiles when addressed ; obeys what he is told to do, 
but speaks with difficulty, using only monosyllables. Pulse 
flagging ; offensive odor from the wound. Saturated the com- 
presses with potassium permanganate, and ordered small and 
repeated doses of quinia? sal ph. and tinct. ferri chlorid. 

March 5th. — For the past few days there has been greater 
hebetude than previously. This morning is very despondent, 
bursting into frequent fits of weeping. Still only able to artic- 
ulate feebly iu monosyllables. A considerable tumefaction has. 
been forming over the site of operation, and is now of the size of 
a large walnut and obscurely fluctuating. Introduced an ex- 
ploring needle and discharged serum and fluid blood, indicating 
secondary hemorrhage outside of the dura mater, probably 
from one of the meningeal arteries, a large branch of which 
coursed directly beneath tlie site of operation. 

6th. — Considerable febrile reaction, headache, and restless- 
ness, which were relieved by making a free incision into the 
tumor and evacuating the contained blood. 

ll//i. — Convalescing slowly ; left his bed and sat up half an 
hour. Is beginuiuft' to frame sentences. Wound open in a 
great part of its extent and discharging pus. 

April ±th. — Has recovered the power of speech ; wound 
almost cicatrized. From this time his convalescence was rapid. 



MEDICAL AND SURGICAL ESSAYS. 129 

On the 19th April he was discharged from the hospital, and a 
fortnight later was sent home by the North German consul, 
perfectly recovered, his general health excellent and his mental 
faculties unobscured. The wound had entirely closed, and a 
depression, in which the end of the finger could be placed*, 
indicated the extent of loss of bone. The edges were smoothly 
rounded, aud a firm, unyielding membrane replaced the bony 
tissue and sufficiently protected the brain from injury. 

The record of this case is, perhaps, not without value. Th 
relative mortality after accidents and operations of this kind 
is usually so great that the successful issue, in this instance, 
when the amount of injury was so considerable and the opera- 
tion was performed after the patient had lain almost three days, 
totally neglected, during which time he had eaten nothing, 
drank but twice, and been allowed to roll his head violently 
from side to side and particularly toward the injured part, 
must encourage us never to despair of a favorable result. 

The operation of trephining has been followed by different results in the 
hands of different surgeons. In general they are anything but flattering. 
In the hosjiitals of Paris the operation is nearly always fatal ; in London, 
Dublin, Edinburgh, Glasgow, and other large cities of Great Britain, the mor- 
tality, although also very high, is much less ; and in the United States, the 
number of recoveries in proportion to the number of deaths is, as nearly as 
we can arrive at the matter, as one to four. (Gross's System of Surgery, 
Vol. II, p. 295.) 

The operation of trephining is by no means a favorable one in its results. 
Of forty-five cases reported by Dr. Lenter, as occurring in the New York hos- 
pital, * * * only eleven, or about one-fourth, recovered. Of thirteen cases in 
which the trephine proper was used at the University College Hospital, by Mr. 
Cooper, Mr. Liston, and myself, four patients recovered. * * * Nelaton says 
that all the cases of injury of the head, iu which the trephine has been used in 
the Parisian hospitals during the last fifteen years, and they are sixteen in 
number, have terminated fatally. (Erichsen's Surgery, p. 295.) 

In oue hundred and seven of these terminated cases, the operation of 
trephining was performed, of which sixty died and forty-seven recovered. 
In one hundred andfourteen cases, fragments of bone or of foreign substances 
were removed by the elevator or forceps, without the use of the trephine ; and 
of these, sixty-one died aud fifty-three recovered. When operative procedures 
were instituted, the recoveries were 45.3 per cent. But it must be apprehended 
that this favorable exhibit will be materially modified when a larger num- 
ber of results are ascertained, and that a great proportion of the field ope- 
rations of trephining, in which the results are stated to be undetermined, 
were lost sight of, and terminated fatally. (Circular No. 6, War Depart- 
ment, Surgeon General's Office, November 1, 1865, p. 9.) 

9 M 



130 MEDICAL AND SURGICAL ESSAYS. 

The recovery of this patient was partly attributable to his 
youth, and evidently strong vitality, but was largely due to the 
excellent care he received Avhile in the hospital, not only from 
Dr. Kidder, who devoted himself assiduously to him, and to 
whose accurate minutes of the case I am greatly indebted, but 
from all the regular attendants, and a large number of volun- 
teer nurses, whose interest was excited by the poor lad's un- 
fortunate condition, and who never quitted his bed-side a mo- 
ment, night or day, during more than three weeks. 



CASE OF DEATH FROM THE BITE OF AN UNKNOWN VENOMOUS IN- 
SECT. 



By Albert L. Giiiox, A. M., M. D., 
Surgeon U. S. Navy, United State* Hospital Ship Idaho, Nagasaki, Japan. 



At 7 o'clock on the morning of September 26, 18GS, Dr. 
Gnillierme Maria Mayer, surgeon of the Portuguese corvette 
Sa da Bandeira, came to the Idaho and requested me to visit, 
in consultation, one of the officers of his vessel, whose condi- 
tion appeared to him very alarming. Eepairing on board, I 
found a young man about twenty-two years of age, of delicate 
physique, lyiug supine in his bunk, comatose, his > pupils dilated 
but not entirely insensible to light, his breathing slow and 
rather fuller than natural, his surface very slightly cool, his 
left hand enveloped in a poultice, on removing which I dis- 
covered a small suppurating wound on the palmar face of the 
middle finger, opposite the articulation of the first phalanx 
with the second, some swelling of the hand, a faint trace of red 
line half way up the fore-arm, and a scarcely perceptible en- 
largement of a lymphatic gland at the bend of the elbow and 
of one in the axilla. 

Dr. Mayer's notes supply the history of the case to this point. 
On the 22d September, Mr. S. consulted the doctor about a 
pain which he experienced on the palmar surface of the middle 
finger of his left hand. Examination revealed a small dark 
point at this site which seemed to have been caused by the 
prick of a perforating body, such as a thorn, though the 
patieut had no recollection of having received such an injury. 
He had been on shore the same day bowling, and remembered 
that his finger had felt a little stiff while he was playing. It 
was slightly inflamed, and a flax-seed poultice was applied 
to it. 

September 23d. — The inflammation had increased and ex- 
tended, and the dark point mentioned was elevated by a small 
purulent accumulation. An incision was made into it, evac- 
uating a quantity of laudable pus, and poulticing was con- 
tinued. 



132 MEDICAL AND SURGICAL ESSAYS. 

24:th, — The wound still discharging a little pus, the hand less 
inflamed, and some pain still experienced, though not so much 
as before. The same treatment was continued, a quantity of 
ol. amygdal. dulc. having been added to the poultice. 

25th. — The inflammation had subsided still more ; the wound 
continued to discharge pus; and the patient declared that he 
felt scarcely any pain. He complained, however, of a marked 
loss of appetite, so much so that his room-mate had great diffi- 
culty in persuading him to take a little broth. This continued 
all day, and was accompanied by a sense of weakness and faint- 
ing, and towards evening by dyspnoea, the patient frequently 
making long, deep inspirations, and placing his hand over the 
precordium. At 9.25 p. m. he became very much agitated, and 
complained of thirst, dryness of the throat, and difficulty of 
swallowing. His tongue was moist and of natural color ; his 
pulse was frequent. A sulphuric acid drink was prescribed, 
and sinapisms applied to the soles. At 10.30 p. m. his agita- 
tion had increased, and a mild delirium set in. Sinapisms were 
applied to the calves. At midnight he attempted to pull off 
the mustard applications, then became tranquil, and passed the 
night more quietly. 

At 4 a. m. of the 26th, his excitement was renewed, and after 
an access of furious delirium, during which his messmates and 
attendants could scarcely restrain him in his bunk, he fell into 
a profound stupor, in which condition he remained until I was 
requested to see him. Not knowing how far the local affection 
had determined the general nervous disturbance, I immediately 
made a deep incision through the length of the finger to the 
bone, evacuating only a few drops of ill-looking pus, and occa- 
sioning scarcely any hemorrhage from the whole extent of the 
incision, the operation exciting reflex movement of the limb. 
Careful examination of the hand satisfied me that the amount 
of local irritation was not sufficient to explain the alarming 
condition of the patient, and I suspected from the dilatation and 
partial immobility of the pupil, the dyspnoea, dysphagia, and 
dryness of the fauces, which had preceded the cerebral symp- 
toms, that the patient was under the influence of a poisonous 
dose of some sedative narcotic ; but his room-mate, who had 
been with him all the time, insisted that this was impossible, 
since the inconvenience he had suffered up to the very occur- 
rence of delirium had been so slight that he had no inducement 
to take anything to allay his pain, even had it been within 



MEDICAL A^'D SURGICAL ESSAYS. 133 

reach, while Dr. Mayer and his assistants further assured me 
that neither any preparation of belladonna noratropia, nor any 
other narcotic had been prescribed, nor was within access by 
the patient. I enveloped the whole hand in a large warm 
poultice, saturated with tincture of opium, applied blisters to 
the calves and fore-arms, sinapisms to the epigastrium and nape 
of the neck, and administered braudy and water as rapidly as 
it could be swallowed, deglutition being still very well per- 
formed, and ordered a stimulant enema, which quickly produced 
a copious fecal dejection. 

At 9 a. m. no improvement had taken place in his condition, 
and I sent for Dr. White of the Ashuelot, and Dr. Kidder of 
the Idaho. The temperature of the skin was then almost nor- 
mal, except in the lower extremities, which began to be sensi- 
bly cool. Unconsciousness was complete; the pupils were di- 
lated and quite insensible to light; there was no congestion of 
the face, nor any injection of the conjunctiva; respiration was 
labored, at the rate of sixteen inspirations to the minute ; the 
pulse was soft, small, and one huudred and thirty-six ; the lips 
were of their natural color; the tongue was dry; there was no 
sensibility of the epigastrium nor abdominal walls; no spas- 
modic movements of any of the muscles; but a decided closure 
of the jaws. Both Drs. Kidder and White at once declared that 
the patient was under the influence of a narcotic poison. The 
same general course of treatment was continued. Bottles of 
hot water were placed to the soles of the feet, and along the in- 
sides of the thighs and legs. Brandy was administered in as 
large quantities as could be taken, and on the coma becoming 
more profound, and the difficulty of inducing deglutition greater, 
it was thrown through au elastic tube high up into the large in- 
testines, in the form of inilk-punch, containing five grains of 
carbonate of ammonium to the ounce, with the effect of speedily 
exciting large liquid stools. The propriety of administering 
opium was discussed, and decided negatively. At 10 a. m. a 
slight movement of the inferior extremities seemed to indicate 
that the blisters were taking effect, and thirty minutes later the 
right hand exhibited partial and temporary tonic contraction. 
As the upper extremities losfc their temperature, bottles filled 
with hot water were applied along their extent, and when no 
more stimulants in quantity could be swallowed, pure brandy 
was slowly dropped upon the tongue, and gaseous ammonia al- 
lowed to be inhaled. The respirations, which were almost noise- 



134 MEDICAL A^D SURGICAL ESSAYS. 

less, became gradually slower; the pulse was regular, though 
smaller, until, soon after 12 o'clock, while I had my ear on the 
chest, the heart suddenly ceased, and the patient soon suc- 
cumbed. 

There was no disagreement among the physicians present as 
to the fact that the patient had died exhibiting symptoms of 
sedative narcotic poisoning; and in the face of Dr. Mayer's pos- 
itive assurance that no agent capable of occasioning such could 
have been received into the stomach, there was only one conclu- 
sion at which we could arrive : That it had entered the system 
at the wound in the finger, which might have been inflicted by 
some venomous insect. In this view Dr. Tedder, lately surgeon 
United States Navy, and then resident physician at the court of 
the Prince of Chosiu, also concurred, though neither himself nor 
any of the Japanese medical men of whom I have made inquiry 
were aware of the existence of any such in this part of Japan; 
but the Sa da Bandeira had recently visited Timor and Luzon, 
where the scorpion is the object of peculiar dread by both the 
natives and resident foreigners, the latter of whom always keep 
an antidote on their tables to apply on being stung. A few 
days before Mr. S.'s death, a strange insect, described as a 
scorpion, was found and killed in one of the officer's state- 
rooms, without attracting especial attention. It is possible that 
this insect, received on board in green fire-wood at Manila or 
Dilly, had only recently been disturbed, wandered into Mr. S.'s 
room and wounded him during his sleep. The amount of local 
injury would have been trifling, although a quantity of venom 
might have been introduced sufficient, after a few days, to viti- 
ate the whole mass of the circulating fluid, when its effects pri- 
marily manifested themselves upon the nervous centers. Mr. S. 
was of a delicate habit, and his vital powers had been further 
reduced by the depressing influences attending a two year's 
residence on board the Sa da Bandeira, a steam sloop-of-war, 
in the usual imperfect sanitary condition of vessels of this class, 
during which period he had, at various times, been ill with 
furunculous eruptions, diarrhoea, fever, epistaxis, and very 
lately erysipelas of the right foot. 

In this connection, and because the testimony is that of a 
very intelligent gentleman, it may be well to quote the circum- 
stances of a case of poisoned wound, inflicted several years ago, 
upon Captain William Furber, now of the Pacific Mail Steam- 
ship Company's service, by a scorpion, on the coast of Central 



MEDICAL A* T D SURGICAL ESSAYS. 135 

America. He relates that while undressing lie experienced a 
singular sensation in the thigh, giving him the impression that 
he had scratched himself upon a nail. Examination of the part 
revealed a small point, the vicinity of which rapidly swelled - and 
reddened, indicating the bite of an insect, which he almost 
immediately discovered to be a large scorpion, at that time 
especially venomous. He killed it at once, and then remarked 
that the pain at the site of sting was become severe and extend- 
ing up the thigh; that a peculiar feeling of rigidity was notice- 
able in the whole limb, and that he experienced a singular 
numbness of the tongue and lips, dryness of the fauces, and 
confusion of mind. Having had considerable practical acquaint- 
ance with such matters, he was aware of the proper treatment 
to be pursued, and at once swallowed a large quantity of undi- 
luted whisky, probably a pint, without becoming in the least 
degree intoxicated, though he subsequently slept soundly. The 
numbness and dryness of the fauces continued several days, 
and the symptoms of irritation at the site of wound persisted 
somewhat longer. 



STRICTURE OF THE URETHRA ; RETENTION OF URINE ; RUPTURE OF THE URE- 
THRA BY THE PATIENT'S ATTEMPT TO INTRODUCE A BOUGIE ; RECTO-VESICAL 
PUNCTURE; SLOUGHING OF NEARLY THE WHOLE INTEGUMENT OF THE ABDO- 
MEN AND PENIS AND OF TWO-THIRDS OF THE SCROTUM ; PERINEAL SECTION ; 
VARIOLA ; PYEMIA ; RECOVERY. 



By Albert L. Gihon, A. M., M. D., 

Surgeon U. S. Navy, United States Naval Hospital, Portsmouth, New Hampshire. 



Private C. T., United States Marine Corps, set. 34, was ad- 
mitted early in January, 1867, into the hospital at the navy -yard 
near Portsmouth, New Hampshire, with stricture of the urethra, 
which had been about a year forming, and had recently become 
so much aggravated that for the preceding fortnight he had urin- 
ated only by drops. On admission he stated that about five 
years before he had had gonorrhoea, which had not been followed 
by any sequela 1 , and two years afterward, while serving in the 
Army, he had a second attack, which affected him severely four 
months, and did not entirely cease running until two months 
later. Some six months subsequent to this he experienced the 
first very slight obstruction to the flow of urine, which, however, 
only became apparent after he had gotten wet and drunk to 
excess. These attacks became more frequent, the stream grad- 
ually diminishing in size until it ceased altogether, the urine 
being voided only in drops, by great effort, attended with pain. 

When admitted into the hospital he was found to have a 
stricture at the bulb, which would not permit the passage of a 
No. 1 bougie. The urethra was excessively sensitive and intol- 
erant of the presence of the instrument. There was consider- 
able irritation about the neck of the bladder. The patient was 
cachectic and debilitated, from previous hard service in the 
Army, and had been still further reduced by exposure while on 
guard during the very severe weather of the month of January 
at this post, and by recent indulgence in drinking, and, proba- 
bly, sexual intercourse while on liberty. He was ordered to be 
kept at rest in a warm room, allowed invigorating diet, and 
directed to make frequent cold applications to the genitals and 
periuseum. 
• He had already improved considerably, when, a few days 



MEDICAL AND SURGICAL ESSAYS. 137 

after his admission, be obtained leave to absent himself an 
hour from the hospital, on urgent private business; bat he 
"went out insufficiently clad, and, as was afterward discovered, 
wandered about in the snow, and drank several glasses of ale 
and hot gin-toddy. He returned after having been absent nearly 
all day, and felt so badly that he immediately went to bed, but 
made no especial complaint to the attendants. The following 
day he urinated with somewhat more difficulty than during the 
preceding week. 

January 19th. — He complained to me, this morning, of exces- 
sive ardor urinoe, and of severe persistent burning pain in the 
penis, which was somewhat swollen. His pulse was accelerated ; 
he had occasional rigors; voided during the day forty ounces of 
urine. Ordered opium in large doses, and applied ice-bags to 
the pubis and periuaeum. 

20th. — Scrotum and penis much swollen, distension extending 
into the perinseuin and left groin. The pain had been relieved 
by the ice-bags, and about twenty ounces of urine had dribbled 
away and been collected ; perhaps as much more was lost. Ke- 
moved the ice-bags, which kept him shivering, and made numer- 
ous deep incisions into the swollen parts, which gave discharge 
to a serous fluid having no urinous smell, and affording great 
relief. Applied warm flannel fomentations, and administered 
opiate enemata. 

21st. — Scrotum, penis, and perinreuin enormously distended, 
and very much discolored ; lower part of the abdomen had also 
become swollen within a few hours; urine had constantly drib- 
bled away until 8 o'clock this morning, when it entirely ceased. 
The patient was in a state of great alarm, his features pinched 
and haggard, pulse small, thread-like, and too rapid to be 
counted, breathing hurried and shallow. I at first intended to 
discharge the bladder by perineal section, but concluded that 
it would be more certain and expeditious to perform the recto- 
vesical puncture, and accordingly tapped the bladder through 
the rectum close to the edge of the prostate, and discharged a 
very large quantity of dark, turbid, highly ammoniacal urine; 
made numerous deep incisions into the swollen parts, and cut 
the prepuce, which was strangulating the glans. Applied warm 
anodyne fomentations to all the affected parts, and ordered wine- 
whey, beef-essence, and opium. 

22d. — Plugged the canula and emptied the bladder every 
three hours. There was no discharge from the numerous inci- 



138 MEDICAL AND SURGICAL ESSAYS. 

sions, which gaped open and were filled with brownish areolar 
tissue. There had been no subsidence of the swelling of the 
abdomen, scrotum, penis, and perinseum, which were all cold 
and discolored. Pulse averaged one hundred and sixty, feeble 
and very small, with extreme prostration, restlessness, uncon- 
sciousness, and dry, brown tongue. Gave essence of beef, milk- 
punch, whisky, etc., alternately, every hour. 

23d. — All the discolored parts sloughing; condition generally 
the same as yesterday, except that he is conscious and able to 
talk; complains of deep-seated acute pain when pressure is 
applied to the abdomen. On being questioned closely, con- 
fessed that, on the lGth instant, while out of the hospital, he 
had wandered about several hours in the snow with some friends, 
drinking hot gin-toddies, etc.; that he was so exhausted on his 
return that he immediately went to bed, and suffered so much 
during the night from inability to satisfy his desire to urinate 
that he attempted to force a bougie through the obstruction, 
using the only one he could find, a No. 6 flexible metal instru- 
ment. After persisting in his attempt almost an hour, the 
obstruction seemed to give way, and he felt the point of the 
instrument on the left side of the scrotum, near the testis. 
Passed a large quantity of blood, but experienced such agouy 
from the distended bladder that he was not sensible of much 
pain at the site of injury, and did not think that he had hurt 
himself seriously. Toward morning felt relieved, the urine hav- 
ing escaped drop by drop during the night. 

2otli. — Removed a large slough, from the scrotum, involving 
two-thirds .of its superfices, completely enucleating the left 
testis, and exposing a considerable portion of the spermatic 
cord. Ou the right side the sloughing was not so deep. Urine 
now escaping quite fast outside of the cauula, which is irri- 
tating the bladder. Pulse one hundred and sixty, somewhat 
harder, wiry ; expression anxious, delirium, jactitation, retching, 
etc. Continued the administration of stimuli. 

2GM. — Detached a slough involving the whole sheath of the 
penis, excepting a small porton of the dorsum of the organ ; 
thin, dark, offensive matter pouring out from the denuded sur- 
faces. The extremity of the canula was causing so much irri- 
tation of the anterior wall of the bladder, and urine escaped so 
freely outside of the instrument, that I determined to remove 
it, and if the fistula closed, open the urethra through the peri- 
nu'um, the distension of which was rapidly abating. Adminis- 



3IEDICAL AXD SURGICAL ESSAYS. 139 

tered a mild enema, -which brought away a large quantity of 
hardened feces and urine. Pulse small, quick, wiry ; skin 
hot and dry ; tongue bard, dry, and brown ; features pinched. 

27th. — Discovered a large abscess which had formed over the 
fifth and sixth ribs on the right side. Observed an eruption of 
numerous papules over the thorax and above the umbilicus. 
Lifted off a number of detached pieces of slough from the ab- 
domen, which was tumid and discolored up to the umbilicus. 
Profuse discharge of thin, fetid, purulent matter from all the 
parts Avhich have been destroyed by sloughing. Filled the 
cavities left by the removal of the sloughs with rolls of charpie 
moistened with liquor soda? chlorinata?, which were removed as 
they became saturated. Passed very little urine per anum, 
aud complained of much tenderness over the pubis. Kept up 
the exhibition of stimuli and repeated the enema, which dis- 
charged a mass of feces and a quantity of urine. 

2Sth. — Patient very low ; pulse one hundred and forty ; small, 
hard; skin dry and burning; mind wandering; restless, &c. 
Opened the urethra by perineal section, discharging a large 
accumulation of urine. Papilla?, having the appearance of var- 
iola, very numerous on the body, and scattered less thickly over 
the head and neck. 

29th. — Eemoved an immense mass of slough from the abdo- 
men, exposing a space extending from the middle of the eighth 
rib of the right side obliquely across the body, immediately be- 
low the umbilicus, to the extremity of the left floating rib, down 
to both iliac crests, and following Poupart's ligaments to the 
pubis, showing the white fibers of the muscular aponeuroses 
beneath ; the whole of this surface, as well as that of the de- 
nuded penis and scrotum, discharging thin, dark, offensive 
pus ; great constitutional disturbance ; small abcesses on both 
legs. 

30th. — Opened a large abscess below Poupart's ligament on 
the left side; thin, offensive matter pouring out from every 
part of the sloughing surface; urine passing freely through the 
perinamm; none through the rectum. 

February 1st. — Has well-marked variola, of which there are 
two cases in another ward of the hospital; pustules large, 
umbilicated, distinct, numerous on the thorax and extremities, 
but not many on the head, face and neck; urine voided freely 
by perinamm. 

2d. — The extensive suppurating surfaces discharging pus 



140 MEDICAL, AND SURGICAL ESSAYS. 

of a lighter color thaii heretofore, which requires to be contim 
ually swabbed out of the cavities. Sinuses extend up toward 
the ribs of the left side, below the left Poupart's ligament 
and aloug both cords into the scrotum, and thence into the per- 
inseuin. Has frequent rigors; pulse quick, corded, somewhat 
larger ; tongue hard, dry, and cracked in the center, softer on 
the edges ; delirious ; continued stimulation by brandy, quinia, 
essence of beef, etc., night and day. 

Ath. — A broad and painful ulcer formed over the sacrum and 
coccyx; pulse one hundred and twenty and fuller; tongue 
cleaning. 

5th. — Variolous eruption desquamating ; purulent discharge 
much thicker, more scanty, and of yellowish color ; ulcers 
granulating ; kept the cavities and sinuses stuffed with charpie 
and, where local stimulation was required, as around the body 
of the penis, saturated the dressing with equal parts of copaiba 
and glycerin. 

7 th. — Granulation proceeding rapidly ; left testis covered with 
granulations r which are also springing up toward it from the 
bottom of the scrotal ulcer ; pulse ninety, softer, fuller ; tongue 
quite clean ; able to have his head raised and to watch the 
dressing of his sores. Uriue has been freely voided by the 
perinseum, and to day began to trickle from the orifice of the 
urethra. 

8th. — Pulse eighty-two; much less purulent discharge; greatly 
emaciated ; appetite ravenous. 

9th. — A bougie introduced at the orifice of the urethra emerged 
at the perineal opening. From the latter site traced a number 
of sinuous passages, terminately respectively ou both sides of 
the mons veneris, above both Poupart's ligaments, at the root 
of the penis and behind the left testis. Was able to keep those 
leading to the abdomen tightly plugged, but urine appeared 
through the two openings on the penis and behind the testis 
whenever he made any stroug effort at expulsion. 

March 1st. — The large excavation on the abdomen slowly fill- 
ing up, and contracting in its vertical diameter. Dressed with 
lint, smeared with copaiba. Left testis completely imbedded 
in granulations, and now cicatrizing, the process being retarded 
by the urinary fistula behind it. Urine freely voided at will 
through the perinamm, and also discharged from the urethra as 
well as before the accident. 

April 1st. — The abdominal ulcer has almost closed. A minute 



MEDICAL AXD SURGICAL ESSAYS*. 141 

fistulous opening - remains on the left of the pubis, at which a 
drop or two of urine appears when an attempt is made to close 
the outlet in the periueeum during micturition. The lost scro- 
tum has been almost entirely replaced ; the testis being drawn 
close up to the pubis, he suffers pain from pressure upon it in 
walking. Most of the urine is discharged through the perinaeum ; 
a small, interrupted stream passes by the meatus. On attempt- 
ing to introduce a bougie, it left the urethra and emerged at the 
perineal opening. Continued the application of copaiba to the 
raw surfaces, and bathed the genitals frequently with cold water. 

15th. — The fistula opening on the abdomen has finally closed. 
A thread-like stream of urine passes from the meatus ; perineal 
fistula contracting. A bougie enters readily to the seat of ob- 
struction, and then leaves the urethra and passes, probably, 
along the course of the original rupture toward the posterior 
part of the left testis, or descends and appears at the perinseurn, 
forming an angle with the channel made by operation, bj r which 
most of the urine is voided, showing the existence of at least 
three fistulous communications around the seat of stricture. 
Directed him to take daily exercise, to continue frequent appli- 
cations of cold water to the genitals, and during micturition to 
make pressure on the perinaeum, to direct the urine as much as 
possible into its natural course. 

29th. — All the ulcers have cicatrized. Bougies enter readily 
to the stricture, and are there firmly resisted, those of small 
size leaving the urethra. The left testis has descended nearly 
two inches ; penis held down by thickened integument. Applied 
ung. iodinii comp. along the course of the indurations. 

May loth. — Perineal fistula very small. A continuous stream, 
the size of a fine needle, passed by the urethra. 

23d. — Made a very long and careful, but unsuccessful attempt 
to introduce a No. 1 bougie into the urethra, inducing so much 
irritation of the canal that the following day he was scarcely 
able to urinate at all. 

June 8th. — Succeeded finally in introducing a No. 1 elastic 
bougie into the bladder ; and before the close of the month had 
dilated to No. 6. The outlet of the perineal fistula quickly 
closed, leaving a cul-de-sac internally, from which a few drops 
could be pressed after micturition. 

July 15th. — Introduces a bougie himself twice a day ; urinates 
without auy difficulty ; cannot walk far without suffering pain 
from pressure on the left testis, which hangs almost as low as 



142 3IEDI0AL, AKD SURGICAL ESSAYS. 

its fellow ; very little disfigurement of penis and scrotum, the 
various indurations having been mostly absorbed ; integument 
movable upon the penis. An irregular, narrow cicatrix, eight- 
een inches long, marks the closure of the abdomiual sore. 

31st. — His inability to walk long distances unfitting him for 
the duties of a soldier, he requested his discharge from the 
Marine Corps, in order to accept a lucrative situation in a cot- 
ton-mill ; and he was accordingly discharged in compliance 
with his wish. 

The winter of 18GG-G7 was of unusual severity and many of 
the men, who after fatiguing guard duty on the preceding 
day, trudged through two miles of deep snow to get to their 
favorite haunts of dissipation in Portsmouth, became seriously 
ill. About the time the case above narrated came under my 
charge, two others of retention of urine, occasioned by exposure 
to inclement weather, also reported to me. One of these suf- 
fered so much pain from inability to urinate, that he consulted 
an incompetent physician, in Portsmouth, who, after an unsuc- 
cessful attempt to introduce a catheter, had him brought to the 
navy yard. He was admitted at night, distracted with pain, 
his bladder so distended and blood issuing so freely from the 
urethra in consequence of the injuries inflicted on it by the in- 
strument, that I expected to have to operate in the morning, 
but succeeded by large doses of opium, and by constant appli- 
cation of hot flannel fomentations, in inducing sufficient relax- 
ation to enable me to introduce a small catheter. The other 
man had a severe gonorrhoea when he left the barracks, and 
returned with a large abscess of the penis, which completely 
closed the urethra, and when opened discharged a quantity of 
pus and urine, leaving a urinary fistula, which required an 
operation before it closed. When private T. returned to the 
hospital he did not appear, to those of the attendants who saw 
him, much worse than when he went out. 1 knew nothing of 
his having been drinking, and was not aware that he had rup- 
tured his urethra by his attempt to introduce a bougie, until 
the 23d, the third day after I had punctured his bladder. He 
had passed so much urine on the 19th and 20th that I attrib- 
uted the increased pain, ardor urinse, and swelling to inflamma- 
tion induced by his imprudence in exceeding his leave of ab- 
sence on the lGth. He was so much relieved on the evening of 
the 20th by the incisions and local applications that 1 had no 



MEDICAL AND SURGICAL ESSAYS. 143 

reason to apprehend the necessity for an operation. During 
the night he rapidly became worse, and when I next saw him, 
at my regular morning visit at 10 o'clock on the 21st, I at once 
made preparations for opening the bladder. 

His case is remarkable for the extent of surface destroyed by 
sloughing, and for the admirable manner in which reparation 
was effected. Within five weeks after its entire exposure, the 
testis had been imbedded in new tissue and completely covered 
with cuticle, the new substance relaxing sufficiently to allow 
the gland to hang nearly as low as its fellow. The uninjured 
abdominal cuticle was gradually drawn, as granulation pro- 
ceeded, toward the pubis and ingniual regions, until only a 
long, narrow cicatrix was left to indicate the longitudinal extent 
of the parts destroyed. The small portion of the sheath of the 
penis, which escaped destruction, formed a thick fold on the 
dorsum of the organ, but the patient objected to its removal 
by operation. His attack of variola was no doubt directly at- 
tributable to the use of a sheet or towel which had been imper- 
fectly cleansed after having been used by one of the other cases 
of that disease in a ward overhead. While the sloughing and 
subsequent suppuration were going on, he consumed incredible 
amounts of eggs, milk, beef-essence, porter, brandy, &c, care 
being taken to administer them only as fast as they were re- 
moved from the stomach, and to maintain a regular and con- 
stant effect upon the pulse. 



AN ACCOUNT OF THE YELLOW FEVER WHICH APPEARED IN DECEM- 
BER, 1866, AND PREVAILED ON BOARD THE UNITED STATES 
STEAMER JAMESTOWN, STORE AND HOSPITAL 
SHIP AT PANAMA. 



By Delavan Bloodgood, A. M., M. D„ 

Surgeon United States Xavyx 



On board the United States store and hospital ship James- 
town, in Panama Bay, December 19, I860, at midnight, William 
McSoley, private marine, was suddenly seized with " pains in 
back," followed by " great thirst and oppression in chest." The 
21st he was " very weak, unable to drill." The 22d he had 
"fever of an ugly character;" "says he feels as he did some 
years ago when he bad severe typhoid fever;" "heat of skin 
very great;" " pulse rapid;" " tongue dry and red at tip and 
edges." On the 24th he was " very much prostrated," and the 
25th, his " prostration continued, with great pains in back." The 
26th, there were " great intestinal irritation;" "mind wander- 
ing;" "delirious at night, and attempted to leave his cot." 
From the last date McSoley slowly convalesced. This patient had 
been employed as sentry at the naval store-house in Panama 
from the 8th to the 19th of December inclusive. I subse- 
quently learned that irritability of stomach was a constant 
symptom during the first few days, of his illness, and that he 
had numerous black liquid dejections. 

Charles A. Gicquel, carpenter's mate, was seized during the 
night of December 30th, with " slight chilliness, followed by 
fever, which has continued ever since;" "fullness of head;" 
" soreness of limbs." These symptoms were attributed to a 
debauch on shore. The 31st, his symptoms were regarded as 
those of " inter, fever," and the next day, January 1, 1867, as 
" remittent fever ; fever recurs at irregular intervals, attended 
with a good deal of nausea ; tongueloaded." January 2d : "Nau- 
sea was very distressing yesterday and last night, and con- 
tinues to-day in a less degree." January 3d : " Tongue coated 
yellow; eyes jaundiced; stomach so irritable as to reject almost 
everything; great thirst, (the stomach symptoms the result of 
his debauch, no doubt.)" January 4th: " Stomach so irritable 



MEDICAL AND SURGICAL ESSAYS. 145 

as to reject all nourishment ; was delirious through the night." 
One o'clock p. m., " Gicquel seems to be sinking ; pulse very 
weak; passing into insensibility ; refuses obstinately to allow 
any medicine to be given him." He died at half past nine 
o'clock that evening. 

Marcellus J. Maxwell, sergeant of marines, was admitted on 
the sick-list January 10th, having had " successive chills since 
last night ; pain in the loins more than usually severe." The 
journal mentions for following three days, " continuous pain in 
back, and soreness of flesh very severe; thirst; tongue coated ;" 
&c, &c. Maxwell was discharged to duty February 2d. I was 
afterward informed by him that he suffered from nausea and 
vomiting during the first few days of his illness, and that in 
convalescence his arms and body became yellow. 

January 12lh.— Edward George Joyce, corporal of marines, 
was admitted on the sick-list with " fever of, as yet, no definite 
character." The 13th, it was called " intermittent," and he was 
reported " convalescent" on the 14th; but loth and 16th "not so 
well ;" " fever at night." The 17th, there was " return of fever ; 
tougue very foul." The 19th, " int. fever ;" " has become con- 
tinued ;" "tongue red at tip, and coated in middle;" "has 
diarrhoea." No further remarks of moment are recorded, ex- 
cepting that " diarrhoea was arrested ;" and " bronchial symp- 
toms had developed," until the 23d, when his condition was 
accounted critical from an "unaccountable and exhaustive diar- 
rhoea." Joyce died at midday on the 24th. During the last 
thirty-six hours of his life, as I learned, vomitings were fre- 
quent, and his corpse turned yellow. 

On the 18th January, four men who had just been released 
from, " the cells " — dark and dank abysses of the orlop deck — 
were admitted and continued on the sick-list five, twenty- 
three, twenty-six, and twenty-seven days, respectively. The 
records of their " chills," "pains," " great prostration," &c, in 
connection with the foregoing and following cases, are worthy 
of particular consideration. 

January 21st, Bernard Hagan, boatswain's mate, was admitted 
with intermittent fever ; the 22d he was charged with being 
drunk, and was disrated ; on the 23d was noted, " has fever and 
diarrhoea;" the 24th, " diarrhoea and vomiting;" 25th, " vio- 
lent retching yesterday, with hiccough," and at evening, " vom- 
iting violent, throwing up mucus and blood." Hagan died at 
10 o'clock that night. 
10 M 



146 MEDICAL AKD SURGICAL ESSAYS. 

Edward Hanson, private marine, admitted at same time with 
Hagan, bad " pains in back," " debility," " fever," " diarrhoea," 
" hemorrhage from nose and montb," but recovered, and was 
discharged from- the sick-list tbe eighteenth day after seizure. 
Tbis man was associated with McSoley (the case first cited) 
as sentry at tbe store-bouse on shore. 

January 23d, Surgeon Marius Duvall, United States Navy, 
was attacked. Passed Assistant Surgeon F. L. DuBois found 
bim, 24tb, with " high fever, intermittent type, result of climatic 
influences and exposure in walking along distance over tbe reef 
in the midday heat of a tropical sun ;" 25th, there was " per- 
sistent nausea and continued feeling of chilliness ;" the 26th, 
" nausea continued — pain in scalp and ears ;" 27th, the same ; 
28th, ""passed a wretched night, retching and vomiting; very 
feeble and prostrate ; has still eaten nothing ; pulse 50;" 29th, 
" stomach* still irritable, but passed a comfortable night by 
taking morphia; relished some champagne;" 30th, "con- 
junctiva quite yellow — nausea and vomiting ;" 31st, " has fever, 
and is flighty." February 1st, "depression of spirits;" " his 
urine has stained his clothes deep yellow." Dr. Duvall left, per 
steamer of 1st of February, for New York, according to recom- 
mendation of board of survey. " In order to prevent tbe spread 
of infection tbe articles used by Dr. Duvall were tbrow T n over- 
board ; the paint within a bath-tub in which he had urinated 
was turned completely black, so abnormal was tbe condition 
of bis urine." 

January 25th, two days after Dr. Duvall's seizure, James Burns, 
private marine, and Michael J. Sweeney, landsman, were 
attacked. Burns hada " hot but perspiring skin ; pain in back ; 
oppression in breathing ; difficulty in swallowing :" 26th, " vio- 
lent emesis :" 27th, "vomiting continued, with fullness in throat ; 
eyeballs congested:" 28th ? the matters vomited were black, 
and he died the following day. Sweeney started off with a 
" chill," followed by " emesis ;" " pains in bead, and conjunc- 
tiva congested f the 26th, be had " vomiting and epistaxis f 
27th, " involuntary evacuations in cot;" "vomitings of blood 
and black matter." Death resulted the next day. 

Appended to the closing accounts of these two cases is the 
following: " The congested conjunctiva, severe pains of back 
and bead, choking sensation in throat, epigastric tenderness on 
pressure, with nausea, and finally the black vomit, like coffee- 
grounds, render it almost certain that we have the yellow fever 



MEDICAL AND SURGICAL ESSAYS. 147 

among us. It has lately been in Panama, but had disappeared. 
At present the city is very unhealthy." 

Following Burns and Sweeney, Thomas J. Ward, ordinary 
seaman, was attacked the day afterward. He had fever, nau- 
sea, vomiting, prostration, yellowness of skin, &c., but conva- 
lesced, and was discharged February 21st. 

Xext day after Ward, William Devine, captain of the fore-top, 
was seized. Vomiting of bile occurred the second day, of black 
matter the third ; suppression of urine, insensibility, hiccough, 
and yellowness of skin succeeded, and death on the fifth day. 

John Dodd, private marine, who had been on the sick-list the 
preceding one hundred days with sj'philis, chronic rheumatism, 
and calculus consecutively, developed, on the 2Sth of January, 
well-marked symptoms of yellow fever — the chills, the fever, the 
nausea and vomiting, yellowness of skin, prostration, &c, but 
sustained it all and was discharged to duty March 25. 

The next case in succession was that of Dennis Kyan, lands- 
man. He had a congestive chill on the evening of January 29th. 
The usual severe symptoms supervened — delirium, black vomit, 
and death on the 4th of February.* 

February 2 John Hasson, captain of main-top, was admitted; 
and the pains, fever, chilliness, nausea, and congested eyes noted. 
February 3 there was continuance of fever and nausea, epis- 
taxis; " is well salivated." February 4th, " yellow serum yielded 
from ablister over epigastrium ;" " great nausea." February 5th, 
he " had convulsions, suppression of urine, vomiting, depression 
of spirits." February Gth, "hemorrhage from mouth." Febru- 
ary 7th, "hiccough, subsultus tendinum, strabismus," and 
death. 

In the night of February 8th, Mr. Johu Adams, acting master, 
had a chill, followed by fever and pains in the head, limbs, and 
back. He took about fifteen grains of quinine each day until 
the 13th, when it was "suspended on account of headache and 
soreness of throat." 14th, his conjunctiva was very yellow. 
15th, the case regarded as quite mild. IGth, " bronchitis super- 
vened." 17th and ISth, "improving." 19th, he was "much 
troubled with cough and expectoration." 20th, " very severe 
bronchitis, with expectoration, of greenish mucus and great dif- 
ficulty in throwing it off his chest ; pulse very feeble ; eyes more 
yellow ; copious watery discharges from bowels." 21st, " breath- 
ing very rapid, secretions all operating save biliary." 22d, " had 
five copious liquid stools ; respiration loud and rapid; delirious; 



14S • MEDICAL AISID SURGICAL ESSAYS. 

spat up blood." He died at 4 o'clock p. m., and his corpse was 
yellow. 

Frederick W. Stevens, private marine, was admitted February 
10, with "intermittent fever," and was given a calomel purga- 
tive, and during the three following days five-grain doses of 
quinine ter in die. On the 14th nausea and the more marked 
symptoms of yellow fever presented, and these were duly fol- 
lowed by epistaxis, hemorrhages, &c, and by death on the 
morning of February 21st. 

Thomas Smith, ordinary seaman, had a chill during the night 
of February 17th, which was followed by fever, and in the mor- 
ning his eyes were much congested. February 19th, " fever, eye- 
ballspainful, slept none, bowels and kidneys acting freely." The 
next day black vomit set in, and he died that evening. 

Isaiah Marjerison, private marine, was seized before daylight, 
February 27th, with the usual chill followed by fever. The second 
morning black vomit appeared, and next day there followed 
delirium, hiccough, and subsultus tendiuum, all of which contin- 
ued until suspended by death, March 2d. 

The cases of Paymaster John A. Bates, jr., United States 
Navy, and John Braumer, private marine, which developed 
simultaneously with Marjerison's, will be reverted to after the 
following necessary explanations : 

Under orders to the Jamestown, I sailed in the mail steamer 
from ]STew York February 21st, 1867 ; reached Panama in the eve- 
ning of March 1st, and went off to my duty soon after sunrise 
the next morning in the market boat. I found fourteen cases, 
five of them very critical, on the sick-list, and that twelve deaths 
had already resulted from yellow fever. The same disease was 
prevailing on shore. Dr. DuBois, whom I superseded as suc- 
cessor to Dr. Duvall, had on three different occasions "fumi- 
gated" the ship, and had advised the commanding officer of the 
necessity for the removal of the vessel from that locality. I also 
proffered the unheeded advice that the ship should sail imme- 
diately for a cold climate, explaining that such a degree of local 
infection existed that there was no hope of the disappearance 
of the endemic fever while material remained for it to work 
upon. I recommended,. also, that shore-visiting be stopped, 
that the prisoners be removed from the cells, and that no one 
be permitted to sleep on the orlop, or remain there longer than 
duty required. It is proper further to remark, in regarding the 
situation, that the Jamestown, newly commissioned, sailed from 



MEDICAL AXD SURGICAL ESSAYS. 149 

San Francisco in October, 1SG0, and reached her station in the 
middle of November, anchoring in the bay about three miles S. 
S.E. from the city of Panama, and about half a mile E. by ]ST. 
from Flamenco, the largest of three precipitous and contiguous 
islands. Flamenco is unused excepting as a burial place, but 
the other two, Perico and Llenas, are occupied by the Pacific 
Mail Steamship Company as depots for stores and coal, and for 
workshops and dwellings for the employes. Her arrival was just 
as the rainy season was closing, which commences in May, and 
during which the miasmatic exhalations are most manifest ; 
when dampness and a greenish mold pervade everything ; iron 
oxidizes with wonderful rapidity; furniture that is only fastened 
by glue falls to pieces ; in short, the appearance and idea of dis- 
ease is constantly impressed upon one. This period usually is 
inaugurated by showers, which may last but an hour or two and 
not recur for three or four days; but as the season advances 
the rain storms become intensified, till, deluge-like, they con- 
tinue from day to day, accompanied by thunder and lightning 
such as can only be experienced in the tropics. The winds, 
which come mostly in squalls, are southerly, but they bring no 
cooling with them, only heaviness and oppression to the nerv- 
ous system. Languor, lethargy, and loss of appetite are the 
immediate results, and fevers and diseases of the digestive 
apparatus the subsequent. This season had passed ; for from the 
•Jamestown's arrival, November 10th, until the end of the quar- 
ter and year of 1SG6, but seven rainy days were logged. Calms 
and light variable winds prevailed, and the average daily tem- 
perature was (Fahrenheit) 78°.2 at 6 o'clock a. m., 84°.l at noon, 
81°.2 at G o'clock p. m., and 78°.5 at midnight. The James- 
town had been in port about a month when the first cases of 
yellow fever appeared aboard her. She was roomy and tidy, 
and well ventilated excepting her orlop, where the pestilence 
made its manifestation among the marines and prisoners, who 
were billeted and kept there, and where also were the bag- 
racks for the men ; and as the clothing and bedding of the first 
three victims were sold by auction to the crew, some of the 
infected articles must have been festering in that locality, which 
locality will again be called iu question. The complement of 
officers and men numbered one hundred and eighteen, of whom 
four officers and three men had had yellow fever, and there were 
fourteen negroes — twenty-one persons who might be regarded 
as exempt from the danger. The report of sick for the fourth 



150 MEDICAL AND SURGICAL ESSAYS. 

quarter, 1S66, affords evidence of the general sanitary tone of 
the ship's company just previous to the outbreak of the fever. 
In those three months but thirty-six diseases had been treated, 
and of those were febris intermittens, one; febris remittens, 
three; febris continua, one; febris typhoides, one; diarrhoea, 
two; dysenteria; one; adynamia, one. The others were but 
trifling affections and injuries. McSoley's and Gicquel's dis- 
eases were included in the foregoing enumeration. 

Passed Assistant Surgeon DuBois was detached ten days 
after I joined the Jamestown. Acting Assistant Surgeon E. T. 
T. Marsh, who preceded me aboard two days, remained a faith- 
ful and zealous coadjutor to the close of the scene. 

To resume the cases of February 27th : Paymaster Bates at first 
complained only of a dull headache, and was taciturn and som- 
nolent. He had no chill, but fever came on at evening and con- 
tinued through the night. He took a blue pill and had a hot 
foot-bath at the hour of retiring. During the following two 
days he vomited frequently and became greatly prostrated. 
When I first arrived on board, March 2d, his mind was clear, and 
he brightened up at seeing me, and was much interested in 
hearing of friends and in his letters, just received; but in less 
than an hour he became bewildered, black vomit was ejected 
and black liquid dejections were frequent, and prolonged sigh- 
ing and hiccough set in. The surface of his body was cool. 
Surrounded him with bottles of hot water, applied sinapisms 
over abdomen and to extremities, and plied him with stimulants. 
Black vomit recurred three times during the day; after each 
act gave him, in mucilage, a few drops of chloroform, in which 
an equal weight of camphor had been dissolved, and again 
small quantities of comp. spirits of oether with brandy; ice ad 
libitum. Throughout the night he was very restless and par- 
tially delirious. Gave him ruilk-punck every hour, and the 
applications of warmth about the body were not relinquished. 
March 3d, his hiccough was very distressing, prolonged, and so 
loud as to be heard all over the ship. Eemedies which the clay 
before mitigated it, then were unavailing. Black vomit stools 
were frequent, and his pulse was scarcely perceptible at times, 
but would come up under extra stimulation. His stomach was 
quite tolerant to soup and brandy. Through the night delirium 
and jactitation were unintermitted. The applications of sinap- 
isms and external heat were kept up, and stimulants given every 
twenty minutes. March 4th, observed about his mouth and ahe 



MEDICAL AXD SURGICAL ESSAYS. 151 

of nose and on forehead, a peculiar vesicular and pustular erup- 
tion ; his body was yellow, and subsultus tendinuni constant, 
and he was also muttering in a tremulous manner. At half past 
10 o'clock a. m. he became quiet for a few minutes, looked up 
consciously, said "Good-by," and died. 

Braumer, attacked at same time with Marjerison and Mr. 
Bates, was greatly terrified. The next day, February 28th, he 
"had spasms and vomiting," and March 1st was "very low." 
When I saw him (morning of March 2d) he was suffering severe 
pain iu the back, and I ordered dry cups along the spinal col- 
umn, milk-punch, and ice ad libitum; flying sinapisms and bot- 
tles of hot water to surround body. March 3d he was very 
restless and tremulous ; the treatment was continued as on day 
before ; 4th of March he vomited occasionally, and his rniud 
was wandering. In the afternoon black vomit appeared, he 
became delirious, and the secretion of urine was arrested. On 
5th of March hemorrhage from mouth occurred, with sore- 
ness of throat; said that he "would die .before sunset." 
Throughout the night he was wildly delirious, shouting, sing- 
ing, and occasionally hiccoughing and ejecting black vomit; 
the external heat was kept applied, and stimulants given freely. 
March 6th he slept some ; stomach was quite tolerant, and he 
voided a little bright yellow urine. March 7th, he had rested 
well during the night ; his mind was clear ; no nausea ; eyes 
less congested ; urine voided ; pulse 48 and feeble ; he continued 
doing well until the 12th, when, obtaining some salts and senna 
surreptitiously, he physicked himself prodigiously, but finally 
recovered and was discharged to duty. 

March 1st Frederick Dallery, landsman, had a chill, and there 
followed frontal headache, pain in back and limbs, suffused and 
pinkish eyes, which subsequently became yellow, as did his 
body; bowels were constipated, tongue pasty, and pulse irreg- 
ular. Xausea and great prostration occurred the second day, 
and continued during the two or three following ones. His 
urine was voided involuntarily, staining the blankets yellow. 
Treatment : Perspiration induced by hot mustard baths, purga- 
tive of calomel followed by oil, hot soups, ice ad libitum, (and 
this for all patients;) also gave him fifteen grains of quiuine 
after catharsis. He was discharged to duty the 17th of March. 

While waiting on the beach the morning after my arrival I 
observed Mr. Charles A. Brown, mate, slowly advancing along 
the reef, frequently stopping to rest. He came up and went on 



152 MEDICAL AXD SURGICAL ESSAYS. 

board with me. He Lad passed the night at a hotel, where 
many deaths had but recently occurred, and where, upon his 
arrival from San Francisco five days previously, he had re- 
mained two days before reporting on board the Jamestown. 
He had had a chill during the night, and the fever was then 
full upon him. As soon as we got on board he took fifteen 
grains of calomel, and was put into a hot mustard bath. But 
very slight diaphoresis followed. He was then given quinine, 
grains fifteen, and the employment of stimulants commenced. 
He became greatly prostrated and agitated, firmly convinced 
that he must die. On the 3d of March he described a pain 
'• like a cord was tied tightly around his back-bone." Nausea 
was constant, but he retained soup and stimulants. Sinapisms 
and bottles of hot water were employed, and he was given Hoff- 
man's anodyne repeatedly. His neck first became yellow, and 
upon it and face were a few vesicles, similar to those observed 
upon Mr. Bates. The secretion of urine was arrested, and black 
vomit set in at 1 o'clock p. in., thin and of the " bees-wing" va- 
riety, which ran from' his mouth as if it was "pumped" out. 
The morning following, besides the black vomiting, black 
liquid stools were frequent ; delirium and hiccough came on, 
and death succeeded at evening. For thirty hours before death 
his stomach refused everything offered. 

At 8 o'clock in the evening of March 5th, Thomas Anderson, 
of the carpenter's gang, who Lad been working at tbe bench 
on the orlop, was seized with a chill. Fever, general pains, 
nausea, and the " white " vomiting regularly succeeded that 
night, and he slept none. He complained the next morning of 
a choking sensation, and the nausea lasted over the 7th. His 
eyes were quite yellow, and ptyalism resulted from a single 
purgative of calomel, followed by oil and quinine. He improved 
rapidly,, and on the 18th, at his earnest solicitation, was dis- 
charged to duty, but the following evening had a relapse, with 
repetition of all original syinptons, from whicL, however, he 
safely recovered. 

March 7tL, the next case developed — that of Herman Zim- 
merman, boy. He was one of the dingy's crew, and for falling 
asleep in his boat, and letting her get adrift when off for mar- 
keting on the morning of the 6th, was kept during the rest of 
the day pulling at Lis oars, in tLe sun, the boat being made 
fast to tLe boom. Tbis did not come to my knowledge till 
some time afterward. Distressing nausea and a sense of gas- 



3IEDICAL AND SURGICAL ESSAYS. 153 

trie distension were first complained of; gave hini an emetic of 
ipecac and mustard, and after its operation the nausea ceased. 
Hot mustard pediluva and bottles of hot water were employed 
without exciting - diaphoresis. He made loud and incessant 
complaints of the pains in his head and back, which were 
scarcely mitigated by large and repeated doses of comp. spirits 
of aether and morphia. Bowels were purged by calomel fol- 
lowed by oil. The second day an abundant vesicular eruption 
appeared on the forehead and about the mouth. Stimulants 
were freely given. Eestlessness, jactitation, and sleeplessness 
unrelieved. Ou the 10th he became wildly delirious, lay upon 
his back, eyes staring, pupils dilated, head rolling from side to 
side, wailiug incessantly, blood oozing from mouth, evacuations 
involuntary, and these conditions were unchanged until sud- 
denly arrested by death, the 11th of March. 

The next case was that of Henry Miller, seaman, a volunteer 
nurse, who had been in faithful attendance from the outbreak 
of the pestilence. He was seized in the night of the 15th of 
March with a chill, and immediately afterward most intense 
pains iu head and back commenced. Several hot mustard 
baths were required before the establishment of diaphoresis, 
whereupon commenced giving twenty-grain doses of nitrate of 
potassa every third hour, and continued it for two days, with 
stimulants p. r. n. ; also took several cut-cups from nucha and 
along spinal column. On the third day a vesicular and pustu- 
lar eruption came out quite thickly ou his face, neck, and arms. 
Nausea, vomiting, great prostration, and unfavorable symp- 
toms generally continued until the 22d, when his convalescence 
began. 

March lGth another case appeared. John Began, gunner's 
mate, had a chill at 11 o'clock a. m., and there was immediate 
and great prostration, followed by " splitting headache," pains 
in back . and limbs, and his eyes were suffused and pinkish. 
Ordered for him the hot mustard bath and a mercurial purga- 
tive. After he had perspired freely for an hour, commenced 
giving him nitrate of potassa, fifteen grains, repeated every two 
hours, and took a few cut-cups from nucha and back. Black 
vomit appeared ou the 18th ; the nitrate of potassa was con- 
tinued with stimulants. On the 19th his ejections were white 
in the morning, but at evening agaiu black; his conjunctiva 
yellow, and an abundant eruption, resembling acne, came out 
upon his "arms and thighs. Treatment unchanged. Ou the 



154 MEDICAL AND SURG-ICAL ESSAYS. 

20th bis stomach was too irritable to receive nourishment or 
medicines, and he again at evening ejected a large quantity of 
black vomit. From the 21st he convalesced, and was discharged 
to duty April 1st with a pretty yellow body. 

Mr. William T. Bull, paymaster's clerk at the naval store- 
house in Panama, died, March 23d, after five days' illness, having 
had black vomit profusely. He had been attended by a resi- 
dent physician, an employe of the railroad company, and who 
denominated the disease " bilious intermittent fever," and de- 
nied that yellow fever existed on the Isthmus. Mr. Bull was 
visited by Dr. Marsh during his illness, and seen by him just 
before death, and he recognized the malady as yellow fever, 
beyond any questiou. 

At about midnight, March 21st, Harrold Xelson, seaman, was 
suddenly attacked. This man had but, recently endured five 
days' confinement in the cells on the orlop deck. He had no 
black vomit, but most of the other prevalent symptoms, and 
they were quite severe in degree. He was discharged to duty 
the twelfth day from seizure, and his treatment was very sim- 
ilar to Began's — nitrate of potassa, after establishment of dia- 
phoresis, being the principal remedy employed. 

Charles Thompson, quartermaster, came off watch at noon, 
March 27th, and reported himself " sick." He seemed stupefied ; 
skin was hot; pulse sluggish ; eyes congested ; and he "ached 
in every part of his body." Put him in the hot mustard bath ; 
gave a calomel purgative ; took four cut-cups from nucha, and 
gave him fifteen grains of nitrate of potassa every two hours. 
March 28th ; lay upon his back all day like a stunned animal ; 
was aroused with difficulty, when he would complain of general 
pains. Put him again in the hot bath ; repeated the cupping, 
and continued the administration of nitrate of potassa. 29th he 
voided six ounces of urine, the first since attacked ; it yielded 
no albumen. His eyes were yellow ; pains unchanged. Con- 
tinued the nitrate of potassa, with stimulants occasionally, and 
employed external warmth. On the 30th a pustular eruption 
appeared about his mouth, and the 31st hemorrhage from 
mouth and nose ; treatment continued as on 29th. He slowly 
convalesced from April 1st, and was discharged to duty 
May 1st. 

April 1st, the commanding officer received from the Secretary 
of the iSTavy an order " to proceed to sea with the J[ainestown 
without delay, and to proceed as far northward as he might 



3IEDICAL AND SURGICAL ESSAYS. 155 

consider necessary for the reestablishment-of the health of the 
ship's crew," and to bring - up at San Francisco. We sailed in 
compliance with that order, April 2d, at evening, the fever hav- 
ing then been endemic aboard over three months. Never men 
more gleefully sprang aloft, never clank of windlass sounded 
more musically than on that occasion. To clear that hated bay, 
to shut out the sight of the head-boards which whitened the 
steep sides of Flamenco Island, seemed like escape from inevit- 
able doom. In that reprieve further calamities were unex- 
pected, inconsiderate of the "ferment'' with which we were 
freighted. 

The day before sailing Charles Hawkins, steerage steward, 
was attacked ; he was excessively prostrated, and there was 
great nervous oppression. Black vomit appeared April 4th, 
recurred twice on the Gth, once on the 7th, and again on the 
8th, and each ejection was profuse. He became delirious the 
Gth, and his mind remained unsettled until the 9th. A minute 
pustular eruption spread over his neck, and oozing of blood 
from the mouth and nose continued many days. The surface 
of his body turned bright yellow after the eighth day, and con- 
valescence began on the 11th. The treatment was commenced 
by hot mustard baths and a mercurial purgative, and during 
the first ten days gave nitrate of potassa in ten-grain doses, 
three or five times per day, as the condition of his stomach 
would allow. Milk-punch, egg-nog, brandy, ale, wine, were 
given as he fancied, and sinapisms and cups were frequently 
called into requisition. 

Louis Eoss, sail-maker's mate, was admitted April 11th, repre- 
senting the common symptoms and appearances. He stated 
that he had been feeling badly for two or three days, but kept at 
work on a sail that was needed. He experienced considerable 
difficulty in breathing, and a sense of thoracic distension ; 
soreness of throat was also complained of, and he vomited fre- 
quently, the ejections containing mucus and bile. He was 
treated with the hot mustard bath, sinapisms and external heat ; 
the nitrate of potassa was regularly continued with stimulants. 
The case progressed favorably without any unusual develop- 
ments, and was discharged the thirteenth day. 

William Jared, yoeman, the next subject, was attacked sud- 
denly and severely in the evening of April 14th ; he was put in 
the hot mustard bath, given a mercurial purgative, and fifteen 
grains of nitrate of potassa every two hours. During the night 



150 MEDICAL AND SURGICAL ESSAYS. 

of the 16tli be became wildly delirious ; surface of bis body aud 
tbe extremities were cold, and bis face and ears leaden bued. 
Took six ounces of blood by cups from nucha, shaved his head, 
repeated the bath, applied sinapisms to epigastrium, and con- 
tinued the potas. nitr. His mind became clearer the 17th, but 
be was very nervous and restless. His eyes and skin were yel- 
low, vomitings of white and bilious matter occasionally streaked 
with blood occurred, and the prostration was complete. He 
recovered, and was discharged tbe eighteenth day from seizure. 
James McBeth, ordinary seaman, came down from his watch 
on deck at 1 o'clock in the morning of April 13th, having a 
light chill, which lasted but half an hour. Gave him two 
ounces of whisky, twenty grains of calomel, and turned him 
in under blankets. In the morning he made but slight com- 
plaint of dizziness and headache ; there was no fever then nor 
during the following day ; his eyes were clear, appetite good, 
and he sle'pt well. EL. — Fitr. potass., gr.x., t. d. The 16th and 
17th nothing apparently was required : he wanted to go to duty, 
which was permitted on the 18th, but that evening he was 
seized with headache and shivering; his pulse was full, and 
eyes suffused and pinkish. He was put into the hot mustard 
bath, and six ounces of blood taken by cups from nucha. Fe- 
ver came on, and continued all night with great thirst, and next 
day with nausea ; he relished and retained however, some mut- 
ton soup and ale. Bowels were opened by calomel, followed by 
sodse et potass, tart., | ss. On the 20th he was greatly pros- 
trated ; said that he "felt half dead and stunned." More 
blood was taken from nuches by cups. He vomited at noon, 
and complained of soreness of throat ; his tongue was tremu- 
lous, black* in center, and yellow edged. Gave him one dose 
of tinct. ferri chlorid., but it seemed to increase the nausea. 
Ordered milk-punch every hour, and flying sinapisms to be em- 
ployed. On the 21st the headache was intense; skin hot like a 
" stove-pipe ;" mind wandering. Again he was put into the hot 
mustard bath, and two cups cut upon temples. At midday black 
vomit appeared, and recurred at evening with hiccough. As 
his stomach would no longer retain milk-punch, its administra- 
tion was continued by enema; external heat kept up. Delirium 
set in at night, and he remained unconscious, with short and 
labored breathing, until noon the next day, when he died. 
Black vomit stools were frequent during bis last day of life, 
and the eruption was abundant on neck and chest, and a few 



MEDICAL AND SURGICAL ESSAYS. 157 

vesicles on the face; the body a dirty bronze color; no albumen 
in urine. 

Accompanying McBethj when he returned in relapse, was 
Alonzo Horton, ship's cook, shivering and complaining of head- 
ache and general pains. The surface of his body was cold, 
pulse sluggish, eyes brilliant. He was kept a long time in the 
hot bath, and afterward surrounded by bottles of hot water 
under his blankets, but without exciting diaphoresis. Several 
cut-cups were taken from his neck and back without relieving 
the pains, which were severest in the lumbar regions. April 
19th, bowels purged by calomel; his tongue had a seared appear- ' 
ance ; gave nitrate of potassa, grains twenty, every two hours 
and a half. The pains in his back were intensified the 20th, 
and sis more cut-cups were taken from the lumbar regions. 
White vomiting occurred at 9 o'clock a. m., black at 2, 4, 
and 9 p. m., with severe cramps, particularly in legs. Suspended 
medicines, on account of the nausea, though stimulants were 
well "borne. Camphor and chloroform mixture given after each 
act of vomiting. 21st of April, no urine voided since S o'clock 
the previous morning; applied warm fomentations over the 
bladder, and resumed the administration of nitrate of potassa, 
and gave milk-punch every hour until midday, when black 
vomit recurred, precluding their continuance. Toward even- 
ing, about an ounce of bright yellow urine was drawn by the 
catheter, and later the same quantity was voided ; no albumen 
contained. Between 7 and 11 o'clock that evening he had eight 
copious black vomit stools. Milk-punch not being well borne, 
substituted undiluted brandy; soon that was ejected, after 
which it was given by enema every hour. The temperature of 
the body continued to diminish. At 2 o'clock in the morning 
of the 22d, hiccough, and delirium of a mirthful character, 
supervened; but soon stupor a»d mutterings succeeded and 
continued until death, which followed before daylight. The 
corpse was completely bronzed in appearance. 

These two cases were the first which had terminated fatally 
in forty -two days. We were then twenty days at sea, and in 
that time had progressed only seven hundred and fifty miles, 
and were still in a lower latitude than the place of departure. 
When the weather had been fair it was calm and stifling; when 
there was wind it came as a rain-squall, and ports were closed 
and hatches hooded, housing us iu noisome vapor. Within a 



158 MEDICAL AND SURGICAL ESSAYS. 

few degrees of the line, a blood-colored sun overhead, a hot and 
coppery sky surrounding, 

" Day after day, day after day, 
We stuck, nor breath nor motion ; 
As idle as a painted ship 
Upon a painted ocean." 

But moderately outfitted with luxuries for the sick, those few 
nearly exhausted, no ice, nor chance for supplies, the prospect 
was dismal, and its disheartening effect clearly perceptible upon 
the ship's company. 

Two days after the burials at sea George Ellis, ordinary sea- 
man, was attacked. The case was quite mild, but in its course 
the diagnosis was unequivocally substantiated. He became 
well enough for duty the ninth day. 

Two weeks after my arrival aboard the Jamestown I had a 
pretty sharp attack of fever, lasting three days, and which, 
though recorded as febris communis, I flattered myself might 
have been yellow fever in mild form. I also assumed security 
from the circumstance that after the arrival north of the 
Dacotah, in October, 1862, with yellow fever aboard, which we 
contracted in the West Indies, I had a fever of considerable 
severity, with many symptoms common to the epidemic; but 
this 27th of April I was suddenly stricken down. A feeling of 
malaise had induced me to take a blue pill that morning, but 
at half past 10 o'clock a chill came upon me with great sudden- 
ness, and lasted three hours in spite of my being twice put into 
a hot mustard bath, bottles of hot water surrounding, and 
blankets piled upon me. With sweating, high fever came on, 
frontal headache, almost insupportable pain in lumbar region, 
cramps in legs, and nausea was constant with insatiable thirst. 
Dr. Marsh gave me, at 2 o'clock p. m., twenty grains of calomel, 
and took two cut-cups from nucha; also employed dry-cups 
along spinal column and flying sinapisms. Dr. Marsh recorded 
that my " eyes were suffused ; tongue foul ; imlse full and hard ; 
great prostration. At 4 o'clock p. m. became delirious. R — 
Mtr. potass, gr. xx. every three hours ; mind became clearer in 
evening." The pains were so intolerable down my back, thighs, 
and legs that the parts were painted over with tincture of 
iodine, : aud a full anodyne of comp. spirits-of aether and morphia 
was administered. The prostration was so complete that I 
could neither rise up nor turn in my berth without assistance. 
Cathartic operated twice in the night ; urine voided. April 



MEDICAL AXD SURGICAL ESSAYS. 159 

2Sth, Dr. Marsh's record is that I " passed a very rest- 
less night ; eyes congested ; tongue black through center and 
yellow at edges; thirst and nausea unmitigated; pulse slow 
and feeble; considerable fever and headache; all these symp- 
toms accompanied by great prostration and disinclination for, 
food ; taking nitrate of potassa, ale, claret, or Sauterne, as 
before." My cognizance of occurrences that day was much 
confused. 29th, " fever continued through the day ; passed a 
very uncomfortable night ; expectorates dark matter, (which 
flowing up in my throat without voluntary effort had a saltish 
and oily taste;) treatment as yesterday. In p. m., on account 
of severity of pains, gave tinct. opii gtts. xl., by enema. Had 
eleven black-vomit dejections during day." 30th, " the erup- 
tion, as mentioned in former cases, appeared about mouth and 
nose; eyes yellow and tongue foul; no inclination for food." 
In the evening was noticed " a great improvement as regards 
all important symptoms." The eighth day from attack I re- 
sumed my duties, though much debilitated and without appetite. 
As sequelae were oozing of blood from my gums, a continuous 
headache, and subsequently a protracted diarrhoea. During 
the first three or four days of my sickness, though realizing the 
impropriety and danger, I could not resist the impulse to throw 
off the clothing and attempt to get out of my berth, and I had 
recourse to various expedients to divert the attention or send 
away the attendants that I might accomplish it ; also, with the 
constant dread of exciting vomiting thereby, I could not restrain 
myself from large draughts if liquids were left within reach ; 
any, however, that were sweetish were particularly distasteful. 
Desirable as it is that the fullest and most minute observations 
be given by physicians of unusual diseases they may have sur- 
vived, L regret, on that account, that during the progress of 
yellow fever in my instance the interest and attention, so far as 
consciousness was complete, were most decidedly personal and 
very little professional. Dr. Marsh declared me to be a most 
troublesome patient. 

Following is Dr. Marsh's record of the case of George Brad- 
ley, corporal of marines, who, an hour and a half after my seiz- 
ure, had a chill lasting over an hour, during which he was 
delirious. Copious perspiration followed after the hot mustard 
bath, and his mind- became clearer. Pains in bead, back, and 
legs very severe, also in thorax. White, vomiting soon oc- 
curred, afterward it was bilious, and at evening dark. Was 



160 3IEDICAL, AND SURGICAL ESSAYS. 

given a mercurial purgative, had cut-cups to neck and back, and 
flying sinapisms were employed. Through night was very rest- 
less ; urine voided naturally. April 28th, eyes suffused ; mind 
wanderiug. Eepeated cut-cups to nucha, and gave hot soups 
and stimulants. No remission of fever, and he again vomited 
black matter. 29th, eyes yellow ; eruption out on forehead and 
neck. Appetite good. Black vomit, with hiccough, set in at 
half past 9 o'clock in the morning, and recurred sis times dur- 
ing the day and evening. Was given aether, one drachm, after 
each act, which afforded temporary assuagement. 30th, five 
ejections of black vomit occurred during the day ; hiccough at 
intervals, mind clear, pulse quick -and feeble. Milk-punch was 
given every hour by enema. Abdomen tympanitic ; applied a 
poultice of mustard aud vinegar, aud gave forty drops of tinc- 
ture of opium by enema. May 1st, black vomit and hiccough 
recurred at 10 o'clock a. m., with great thirst, and he became 
delirious at 2 o'clock ; later he passed a perfectly white and 
clayey stool, and gulped up a large quantity of black vomit, 
continuing unconscious, with short and labored respiration 
until evening, when he died. 

Two and a half hours after my attack, and one after Brad- 
ley's, Mr. Leakin Barnes, acting ensign, was similarly and as 
suddenly taken. His chill was prolonged, prostration and 
pains were excessive, and the matters vomited were white at 
first, and afterward streaked with blood. The eruption, which 
was quite extensive, appeared the third day. He convalesced 
favorably. Treatment, very nearly as described in preceding 
cases. This officer was an inveterate smoker and also a chewer, 
but after recovering from this disease his taste for tobacco was 
entirely lost, nor had it returned when I last saw him, the fol- 
lowing year. • 

April 29th, Charles Brown, ordinary seaman, was seized. He 
described his pains as " wicked." The disease progressed 
rather mildly ; the diagnosis, though, was fully confirmed, and 
7th of May he was convalescent. 

William J. Bothmau, carpenter's mate, was the next attacked, 
on the 3d of May. The third day afterward the secretion 
of urine was arrested, and black vomit set in with delirium. 
He died May 9 th. The eruption was present, and petechial on 
abdomen. No albumen in urine. Treatment very similar to 
Bradley's. 

Edward Slackford, ordinary seaman, was seized with a severe 



3IEDICAL AXD SURGICAL ESSAYS. 1G1 

chill, followed by fever, pains, nausea, &c, at 1 o'clock p. m., 
and George Thompson, private marine, at 4 o'clock the oth of 
May. The eyes of both were congested and pinkish ; both vom- 
ited white and bilious matter in the evening, and became deliri- 
ous. All of their symptoms were very similar, save that Slack- 
ford's prostration was the more excessive and his delirium 
lasted the longer. Their nausea and vomiting continued, and 
at the same instant, in the evening of the Sth, each ejected 
about a quart of black vomit. The eruption appeared on both, 
and their eyes and skins were yellow. No albumen was de- 
tected in the urine of either. On the fifth day a favorable 
change occurred with each, though both were greatly pros- 
trated, and Slackford wonderfully emaciated. Thompson was 
discharged to duty May 22d, and Slackford 24th. Treatment, 
as hereinbefore particularized — nitrate of potassa after diapho- 
resis was excited, and after purgation and stimulants p. r. n. 

Peter Sullivan, captain of the forecastle^ in the evening of 
the 10th of May, experienced sadden prostration, with frontal 
headache and pain in back and legs; eyes were dull, skin damp, 
pulse sluggish, tongue pasty. Soon after he had a chill, suc- 
ceeded by fever and vomiting of white and bilious matter, and 
the pains in lumbar region became intensified. The eruption 
appeared iu due time, and the disease subsided as in regular 
course. No trace of albumen in urine. He was discharged the 
19th, but iu four hours relapsed. By the 24th, he was well 
enough for duty. The treatment was employed Avhich had 
almost become " stock." 

Edward Smith, apothecary, a youth of nineteen, accom- 
panied me from New York, accepting his appointment knowing 
of the pestilence to be encountered and of the great danger to 
an unacclimated person suddenly migrating from a northern 
winter to an infected ship in the tropics. With a view to 
prophylaxis I gave him two grains of quinine morning and 
evening during the week after our arrival, and pil. hydrarg., 
grains five, at intervals of ten or fourteen days; also five grains 
of nitrate of potassa with the quinine. This course was re- 
sumed for a few days at a time at irregular intervals for two 
months, and stimulants were occasionally given when his duties 
were more than usually fatiguing. Regular bathing was prac- 
ticed. But, in the evening of May 11th, he was seized with 
typhus icterodes. We put him into the hot mustard bath, and 
gave pil. hydr., after which high fever came on and his mind 
11 M 



102 MEDICAL AND SURGICAL ESSAYS. 

wandered. White vomiting occurred several times, his thirst 
was urgent, and he complained of a burning sensation in his 
throat. Flying sinapisms and bottles of hot water about his 
body excited but slight diaphoresis. Took three cut cups from 
nucha. The pains were unrelieved, and he slept none; a burn- 
ing fever continued all night. Next morning warm saline 
enema? produced but one small stool ; the mercurial was re- 
peated, and three cut-cups taken from his lumbar region ; his 
head was hot, pulse 120, tongue seared. In the afternoon the 
hot mustard bath was repeated, inducing diaphoresis and mod- 
erating the fever and pains. Gave him claret and gum-water 
ad libitum ; also nitrate of potassa, grains ten, every two hours, 
which was retained, though food excited A r oiniting. In the 
momentary absence of the nurse he got up, prepared and swal- 
lowed about two drachms of citric acid in six ounces of Tarra- 
gona wine. May 13th, 2 o'clock a. in., fever and delirium 
increased ; skin like a " stove pipe ;" bowels unmoved; repeated 
the saline enema without result. At 4 o'clock be became quite 
unmanageable; two more cups were taken from nucha and 
three drachms of potassse bitartras administered ; after this he 
slept for a short time, the first since attacked, and his urine 
was voided involuntarily. The nausea ceased so that he ate a 
little tapioca ; he took also milk-punch every hour, and nitrate 
of potassa, grains ten, every two hours. But soon the delirium 
increased, and his head rolled from side to side, with pupils 
widely dilated. At half past 9 o'clock gave a turpentine enema 
without effect. Abdomen tympanitic; rubbed it over with 
croton oil and applied a large blister. Three drops of croton 
oil were placed upon his tongue, but no movement resulting, at 
2 o'clock p. m. gave him another turpentine enema, when half 
an hour afterward there came away in his cot a large quantity 
of black offensive feces, and in the night he had two more 
involuntary evacuations, black and very offensive. His deli- 
rium became so violent that we were obliged to anaesthetize 
him, in which condition he rested an hour and a half. May 
14th, not a favorable indication; five ounces of bright yellow 
urine were drawn by catheter, none had been voided in twenty- 
four hours ; it contained no albumen. At 5 o'clock p. m. black 
vomit appeared, and recurred repeatedly and profusely in the 
night. He died early in the morning, May loth. 

Mr. Eobert H. Carey, acting ensign, was seized with chill 
and pain in head and back just before midnight, May 13th, and 



MEDICAL AND SURGICAL ESSAYS. 1G3 

soon after vomited white and bilious matter, and the vomiting- 
was repeated several times before morning. Copious diapho- 
resis was induced by covering him with blankets and giving 
hot drinks. R. — Pil. kydr., gr.xx. Statim. 

14th. — He had high fever, frontal headache, pains down in- 
side of thighs and legs, great thirst; his eyes were congested 
and pinkish, tongue white and flabby, pulse full, though not 
much accelerated. Four ounces of blood were taken by cups 
from his nucha, and he was given one drachm of nitrate of 
potassa during the day. At evening he had three black stools, 
and was stupid and somnolent. 

15th. — He had slept all night, and was aroused with difficulty 
in the morning, when he complained as on the previous day. 
The general appearances were unchanged; skin and kidneys 
secreting; bowels free. 

lGth. — Still very somnolent. Eyes and skin yellow ; eyeballs 
painful ; no appetite ; eruption out on neck and arms. Con- 
tinued the nitrate of potassa, but no stimulants were given. 
He commenced convalescing the 17th, and the 22d was recov- 
ered. 

Thomas Toner, landsman, was seized with a chill at half past 
2 o'clock p. m., May 15th, and had the characteristic pains, with 
constant nausea. His left eye was merely suffused, while the 
right was entirely pink. The si'ght of the latter had been de- 
stroyed some years before, but in health the appearances of 
both eyes were similar. Ordered for him the hot bath, purga- 
tive, and nitrate of potassa. 

lGth. — He had considerable fever, but his pains had dimin- 
ished to a sense of general "soreness of flesh." Pulse was 
feeble and quick; appearance of eyes unchanged; skin moist; 
urine voided naturally. Continued the nitrate of potassa, with 
stimulants. 

On the 17th there commenced a general improvement, and 
from that date progressed favorably, and patient was dis- 
charged May 23d. The eruption appeared on neck and chin. 

Peter Harmes, ordinary seaman, was attacked suddenly, and 
at same time with Toner. There were great prostration, pro- 
longed chill, and intense pains. High fever followed after the 
bath. Nausea was constant, and fever, with a "stove-pipe 
skin, 1 ' continued throughout the night. Gave him twenty 
grains of nitrate of potassa every two hours, and took blood 
from nucha by cups. 



164 MEDICAL AND SURGICAL ESSAYS. 

lGtlu — Bowels purged by calomel, given at the first; no mod- 
eration of the fever ; nausea distressing. Continued the nitrate 
of potassa. 

17 th. — Stupor and nervous depression; eyes yellow; tongue 
black; neuralgic pain in testes; nausea unrelieved. No urine 
had been voided in forty-eight hours. Drew off, by catheter, 
nearly a quart, which yielded an abundance of albumen. Con- 
tinued the treatment. 

19th. — A decided improvement commenced and continued. 
He was discharged May 27th. The eruption appeared on face 
and neck. 

William Martin, steerage cook, was attacked before daylight, 
17th of May, and all symptoms were grave. Employed the hot 
mustard bath, bottles of hot water, and gave purgative dose of 
calomel. High fever continued all day, with great thirst, nau- 
sea, vomiting, and prostration. He took fifteen grains of 
nitrate of potassa every three hours. At evening white vomit- 
ing recurred, and the heat of skin and pain in head increased. 

ISth. — He passed the night very restlessly ; stupor had ad- 
vanced; skin yellow and dry, and emitted a musty and offens- 
ive odor; tongue dirty yellow, and denuded at edges; pulse 
excited and irregular. He was again put into the hot mustard 
bath, the nitrate of potassa continued, with milk-punch ad 
libitum. He became delirious, at evening, and his urine was 
albuminous. 

19th. — No improvement; eruption thick on face and neck; 
medicine and stimulant continued as on preceding day. 

20th. — Hemorrhage from mouth and nose occurred, and black 
vomit appeared at half past 10 o'clock a. in., and recurred sev- 
eral times during the day and evening. Delirium and hiccough 
also continued, and convulsions supervened before death, which 
resulted early in the morning of May 21st, our forty-ninth day 
at sea, in which time we had experienced twenty-six days of 
heavy rain, and the average daily temperature had been — maxi- 
mum, 85°. 7 ; minimum, 80°.3 F. 

Henry Duell, ordinary seaman, was attacked May 19th, early in 
the morning, and pretty severely. Treatment, after the routine 
of cases, subsequent to leaving Panama. A decided and unu- 
sual improvement occurred during his second day of illness, 
though the distinctive features of yellow fever were observable. 
The favorable change I attributed, in good measure, to a dimin- 
ution in temperature of ten degrees. 



MEDICAL AND SURGICAL ESSAYS. 1G3 

The last case developed May 23d, in latitude 22° 35' north, 
longitude 12G° west ; temperature maximum 72°, minimum 68°. 
John Smith, quartermaster, wan the subject. He was taken 
with a chill, followed by nausea, supraorbital headache, con- 
gested and pinkish eyes, incrusted tongue, severe pain in limbs 
and lumbar region, and fever of moderate character, which was 
maintained without any variation two days. The fourth day 
his eyes and skin became yellow. He was discharged to duty 
May 28th, our fifty-sixth day from Panama. San Francisco was 
reached June 7th, and our pilot's was the first sail to greet our 
eyes throughout that memorable passage of sixty-six days. 

Thus succinctly is presented the inception, progress, and ter- 
mination of as malignant an outbreak as our service has endured. 
Forty-eight cases and twenty-one deaths are enumerated, of 
which nineteen had developed before my arrival, and thirteen 
of them had fatally terminated ; twenty-nine cases, with eight 
deaths, subsequently resulted, twenty of which, and six deaths, 
occurred at sea. In regarding this summary, it is noticeable 
that three persons died without having had black vomit or sup- 
pression of urine ; one who died was ptyalised at an early stage 
of the disease; six recovered after having black vomit; three 
survived in whom the secretion of urine was arrested; eight 
recovered, having been delirious ; after hemorrhage from mouth 
and nose five recovered ; nine had black- vomit stools, of whom 
seven died ; the urine of eleven patients was tested for albumen, 
and it was found but in two — one of those two patients died. 
Possessing but a small quantity of nitric acid, and no test-tubes, 
we were unable to render fuller statistics in that particular. 
Had the means for hypodermic medication been possessed, 
much more suffering could have been alleviated than our re- 
sources afforded. Should duty again circumstance me as in the 
instance recounted, I would hardly employ a less effectual and 
prompt cathartic than croton oil. Mercurials were not obvi- 
ously beneficial. I could not discern any utility from the ad- 
ministration of quiuine, and early discontinued its employment, 
though on board the Dacotah, in 1862, its efficacy was very 
marked ; but before the epidemic in that ship, our crew had 
suffered severely from malaria, encountered during the summer 
up the James Eiver, while cooperating with the Army in the 
first peninsular campaign. But those manifestations were quite 
different from these of the Jamestown, and were much milder 
in type. On the Dacotah we had twenty-five cases, and not one 



100 MEDICAL AND SURGICAL ESSAYS. 

was lost ; in two only did black vomit appear, and but in about 
balf of thein were displayed the characteristic discolorations. 
Beyond the modifications first before suggested, I would not 
depart from my line of treatment pursued. Especially effica- 
cious seemed the agency of the nitrate of potassa as an elimi- 
nator of the poison by its diuretic and diaphoretic action, and 
not in a single instance did it seem to incite or increase visceral 
irritation. The moment for commenciug stimulation, and the 
extent to which it may be carried, cannot be indicated by any 
general rule, but can only be judged by the particular conditions 
in each individual case. 

Some further observations than the few herein before given 
respecting topography and meteorology may be relevant and 
appropriately introduced here. 

The walled city of Panama occupies a small peninsula about 
half a mile long by one-quarter in width, extending easterly 
from the bases of Mounts Ancon and Gabilan. The walls are 
crumbling in many places and the western line and portion has 
been pulled down, and the wide and deep moat filled in for 
roadway crossings in some places, but generally it is only piled 
and choked up with deposits of rubbish and filth. "Within the 
city proper is a population of from three to four thousand, and 
nearly the same number inhabit the arrabal or collection of mis- 
erable abodes which extend like excrescences from the walls. 
Drainage is unknown ; even the water for drinking and culinary 
purposes is brought in on donkeys from a stream by no means 
taintless outside the city limits ; water for the shipping, how- 
ever, and with which we were supplied, is obtained from a 
stream on the island of Toboga, nine miles away to the south- 
ward, and though reputatively very pure, is somewhat question- 
able to those who have observed the laundry and bathing ope- 
rations along its course, as descending from the mountain it 
lingers in shady and convenient pools. Scavengers are want- 
ing, too, in Panama, save the buzzards ; and the habits, persons, 
and dwellings of the lower orders, (most interminably mixed as 
to blood,) both without and within the walls, are repugnant and 
filthy. Disgusting odors assail the nostril at every turning, and 
the visage and demeanor of the denizens in general bear evi- 
dence of the perniciousness of their climate and its enervating 
effect. The tide rises fully twenty -two feet up to the city walls, 
but in receding leaves bare long ledges of volcanic rock and 
coral with sand patches between, which afford lodging places 



MEDICAL AND SURGICAL ESSAYS. 1G7 

for offal and other refuse thrown out. Upon the ramparts, 
turning - from the charming view of the islands which, under the 
enchantment of varied distances, adorn and diversify a bay next 
in celebrity after Naples and Eio, there is afforded a vista even 
more attractive — of mountains and gigantic forests, of valleys 
and jungles impenetrable, of lagoons within savannas on which 
half wild herds are grazing, and where the foliage is rankest and 
flowers most gaudy are hidden the bayous with their slimy 
banks ; and there, too, beneath the damp shade of the profuse 
vegetation which decomposes under the influences of moisture 
and a constant summer heat, is the lair of intensest miasm. 
The whole Isthmus is its habitant and has been for years, and 
undoubtedly will be to the end of time, and from no part or 
place has it been or can it be excluded. Acclimation is impos- 
sible ; no one, of whatever race or country, who becomes a resi- 
dent of the Isthmus escapes disease ; not even are beasts ex- 
empt, and nothing but change of climate can eradicate the 
effects of the poisoning from that malaria. Intermittent, remit- 
tent, bilious, and congestive fevers and dysenteries are the 
usual results of the climatic influences, but under intenser 
excitation yellow fever appears. The belief is well grounded 
that yellow fever never leaves certain localities which it has 
once invaded and where the conditions for its existence are 
constantly maintained. It may seem dormant for a time, or 
only sporadically evincing its life before it rouses itself and 
appears epidemically. I know that it existed at Panama, at 
Toboga, and among the shipping of the bay while I was attached 
to the frigate Merrimack on the Pacific station in 1857-59, and 
that it has played havoc in each of those designations several 
times since. At Aspinwali, when en route to the Jamestown, 
the la.e Dr. Kluge (victim at last to the Isthmus malaria) told 
me tint he had recently treated ten employes of the railroad 
company who had yellow fever, and eight of them died. And 
at that time the numerous deaths along the line from Aspin- 
wali to Panama were exciting special comment, though they 
were attributed to bilious, congestive, remittent, and intermit- 
tent fevers, or by two or three or more of such nosological com- 
binations of terms a nomenclature 'was provided less oppugned 
to lucre tian yellow fever, but none the less fatal to human exist- 
ence. Tie evidence of the direct transportation of the yellow 
fever fron Panama to the Jamestown is clear and indisputa- 
ble, thourh for my temerity in maintaining that proposition, 



1CS MEDICAL AND SURGICAL ESSAYS. 

and for intimating that the Isthmus has not par excellence the 
most salubrious of climes, I drew upon myself the maledictions 
of the two Panamanian newspapers, the organs respectively 
of the two great commercial enterprises, in which leaders with 
emotional headings established "The health of Panama," and 
vituperated "The Jamestown's Surgeon." Even a "member 
of the Eoyal College of Surgeons, England," in the employ of a 
third commercial organization, under his distinguished sign- 
manual published and proclaimed the sound sanitary condi- 
tion of the Isthmus. The pestilence was conveyed, unques- 
tionably, from the shore to the ship three miles out in the bay, 
firstly, by McSoley and Hanson, the marines who were on duty 
at the store-house in one of the most unhealthy locations in Pa- 
nama, from December Sth^to^the 19th, at which last date they 
were returned on board with their bags, hammocks, and accou- 
terments ; and that night of the 19th McSoley was attacked 
with yellow fever, and Hanson was on the following 21st of 
January. Secondly, by Gicquel, who had been on shore for 
several days and nights doing some work for the commanding 
officer, and who, December 23d, was brought on board and con- 
fined under the sentry's charge ; he was attacked with yellow 
fever one week afterward, and died. The propagation of the 
pestilence was consummatedfon the orlop deck, where McSoley 
and Hanson stowed their effects and slung their hammocks ; 
where McSoley remained through his sickness ; where Gipquel 
was confined, where he worked at the bench, where h<i was 
taken sick and remained until [the day before his death, \fhen 
he was removed to the gun deck ; where Sergeant Maiwell 
was sick, and where he and^the other marines who hal the 
fever slept ; where the cells were from which the four patients 
were relieved January 18th ; 'where some of the infected /cloth- 
ing of the first three victims^ probably was stowed aftei their 
deaths, and its distribution among the ship's company I where 
Anderson, attacked March 5th, worked at the bench, anl after- 
ward Eothman, who died ; and where Nelson had been confined 
for five days just before his^seizure. In other localitiesithe fer- 
ment seemed also to linger ; for instance, I succeeded to Dr. 
Duvall's room and disease; after Mr. Bates's death I Ensign 
Barnes occupied the paymaster's room, and had the fefer ; Mr. 
Carey was attacked in the room next to the one in wiich Mr. 
Adams died, and with which there was communicatior through 
the bulkhead ; the officer who took Mr. Adams's roomhad had 



MEDICAL AND SURGICAL ESSAYS. 1G9 

yellow fever. The attendants upon the sick suffered to an ex- 
tent that almost typified contagion. Dr. Duvall was among 
the early sufferers ; (Dr. DuBois having had the disease in the 
Gulf of Mexico, was an exempt almost to a certainty ;) Miller, 
the constant nurse up to March 13th, was then stricken down ; 
my attack came next in order; then Edward Smith, the apothe- 
cary, sickened and died; and last Bradley, who was acting 
apothecary when I arrived with Smith, and who was retained 
as nurse and assistant in the dispensary until his fatal sickness. 

It is pertinent, in considering the portableness of yellow fever, 
to cite the instance of the mail steamer Golden City, which ar- 
rived at Panama March 4th, and the same day an officer of the 
Jamestown removed his wife from their lodgings on shore to the 
steamer, for passage to San Francisco. Each day there was 
communication between our ship and the steamer, and a quan- 
tity of luggage was transferred from tile former to the latter. 
The Goldeu City sailed on her return trip March 10th, and before 
reaching Acapulco the servant that attended the room occupied 
by the officer's wife (and by the officer also at Panama) died of 
yellow fever ; and three other cases and two more deaths re- 
sulted before the cold latitudes were reached. It is possible 
that the " ferment" was received on board from the shore, but 
more probably it was carried from our ship — a question distress- 
ing to the parties who innocently but unwarily were thus con- 
cerned in it. 

It is to be remembered that the rainy and sickly season ended 
before the pestilence broke out on the Jamestown, and that her 
stay at Panama was in the dry or healthy period, the climatol- 
ogy of which I daily observed and considered ; and as evidences 
of its general phenomena, I noted that the average daily tem- 
perature during the first quarter of 1867 was (F.) 78°.2 at 6 
o'clock a. in., 84°.2 at noon, 81°.9 at 6 p. m., and 79°.l at mid- 
night. There Avas an absence, for the greater part of the time, 
of northerly winds, which are commonly prevalent throughout 
the dry season, and rain showers occurred quite frequently, so 
that the unpleasant dampness and moldiness penetrated every- 
where — into books, bedding, clothing, and packages, no matter 
how secured. The atmosphere was sultry and stifling, and 
earthquakes, though slight, were not infrequent. In name only 
was the season either dry or healthy. At San Francisco I was 
permitted by the health officer of the port to examine the sani- 
tary reports furnished him by the surgeons of the Panama 



170 3IEDICAL AND SURGICAL ESSAYS. 

steamers on their arrival. I do not remember an exception but 
that, on every return voyage, for mouths from and after Decem- 
ber, 1S6G, cases of yellow fever, or some exceediugly suspicious 
diseases, were returned ; and the same held true at the port of 
]?ew York. I have in preservation a formidable list of deaths 
which resulted from crossing the Isthmus in the ordinary line 
of travel, during that year of 1867. An officer on board the 
United States steamer Eesaca, at Panama, July 1, 1867, wrote 
me that " The fever still continues here, deaths five per diem 
just now. One by one the strangers are picked off. The 
Panama Mail Steamship Company's steamer Montana had sev- 
eral cases, and lost two engineers just before leaving here last 
trip. The Bolivia (Colombian man-of-war) has it aboard, and 
we have ceased all communication with the shore." Ten days 
afterward, the commanding officer of the Eesaca reported that 
" the fever had appeared on the ship, and that by advice of the 
medical officer, he should leave immediately for a cold climate ; 
that it was very fatal among foreigners and the troops ashore ; 
and that the surgeon of Her Britannic Majesty's steamer Scout 
had just died of it." (Mueteen others also died aboard the 
Scout before she reached Esquimalt, Vancouver's Island, for 
which port she started at the instant of the appearance of the 
yellow fever among her people.) The Eesaca drove northward 
under full steam, but before gaining the harbor of San Fran- 
cisco, sixty-eight of her crew were stricken down and seventeen 
corpses hove overboard. 

The Jamestown and Eesaca were ordered to Sitka for disin- 
fection by cold, and I rejoined my ship there in October, about 
a month after her arrival ; and the following month I " certi- 
fied" that, in my opinion, any cause sufficient to re-propagate 
yellow fever within the Jamestown had ceased to exist ; that 
frost or a low temperature, when continued a sufficient length 
of time, will effectually destroy the " ferment j" and that I con- 
sidered that a sufficient length of time had elapsed. The Eesaca 
returned south in January, and though she has been employed 
in the tropics a good share of the time since, has not had an- 
other case of the fever. We, in the Jamestown, passed the 
winter in Alaska, and sailed from Sitka the last of May for 
Puget Sound, and thence to the Mare Island navy-yard, where 
our scarred veteran was dismantled. 

The following winter, on returning to the island, I found the 
Jamestown refitting for sea; and though during her winter in 



MEDICAL AND SURGICAL ESSAYS, 171 

the boreal regions she had been thoroughly broken out, cleansed, 
dried, and whitewashed three separate and several times, it was 
insisted upon as necessary that she should be " steamed," and 
accordingly was put through that process. She sailed finally 
on her cruise and into the tropics, where she has since been 
principally employed, and now is, without having contracted 
any unusual sickness aboard. 

320 Clermont Avenue, Brooklyn, May, 1871 . 



AN ACCOUNT OF THE EPIDEMIC OF YELLOW FEVER WHICH APPEARED ON BOARD 
THE UNITED STATES STEAMER SARATOGA, IN JUNE, 1809. 



By Lewis S. Pilcher, Passed Assistant Surgeon, V. S. JV. 



The United States steamer Saratoga, 3d rate, came to anchor 
in the harbor of Havana, May 10, 18G9, having left New York 
on the 21st of April previous. Her complement of officers and 
men comprised 17 officers, 105 men, 78 naval apprentices, and 
24 marines; in all, 221 souls. She remained at Havana, not 
changing from her original anchorage, till the 7th of June fol- 
lowing, when, cases of yellow fever having appeared on board, 
with two deaths, she put to sea. Prior to leaving, a medical 
officer was transferred to her from the United States steamer 
Penobscot, on account of the death of her own surgeon. She 
arrived at Key West, Florida, June 10th, whence she set sail 
the following day, June 11th, under orders to proceed to Ports- 
mouth, New Hampshire. Owing to the rapid extension of the 
disease, she put into New York, arriving there June 20th. 
During the passage from Key West to New York three deaths 
occurred. Immediately on arriving at the lower quarantine 
station in New York Bay, the sick, sixteen in number, were 
transferred to the hospital hulk Illinois. Seven new cases re- 
ported on the 21st, and one on the 23d ; these, with one excep- 
tion, were also transferred to the Illinois. 

At noon of the 23d, the United States steamer Frolic was 
towed down from the navy-yard, and the entire remaining ship's 
company transferred to her. The crew received an entire change 
of clothing, but were obliged to take with them their old ham- 
mocks, blankets, and mattresses. The officers were allowed to 
take their bedding and the clothes they had on at the time, 
only. The Frolic was anchored near the Illinois, and the officers 
and crew of the Saratoga retained on board her, in quarantine, 
until July 7th, but two more cases of fever appearing during that 
time, one on the 21th, and one on the 28th of June. They were 
relieved from quarantine July 7th, and transferred to the receiv- 
ing ship Vermont, at the navy-yard. During the course of the 
epidemic, thirty-seven cases occurred, with seventeen deaths. 

Iu the harbor of Havana, during the spring and early sum- 



3IEDICAL AXD SUKGICAL ESSAYS. 



173 



mer of 1869, at tlie same time with the Saratoga, were the 
United States steamers Albany, Narragansett, and Penobscot. 
The first of these, with one or two short intervals, had been 
there since November 15, 1868 ; the two latter bad been either 
in the harbor of Havana itself, or in neighboring ports of 
Cuba, since the beginning of March. The Albany and the 
Penobscot were in port at the time of the outbreak of the epi- 
demic on the Saratoga. Of these vessels the Saratoga alone, at 
this time, was visited by the disease, although later in the sea- 
son, on both the Albany and the Narragansett, a few cases 
occurred, and on the Penobscot, which left for the North at the 
same time with the Saratoga, seven cases reported as remittent 
fever, none fatal, occurred before reaching Portsmouth, New 
Hampshire. 

During the summer of 1S69, yellow fever was prevalent 
throughout the West India Islands, but not to such an extent 
as to be considered in any place as epidemic. Out of the seven 
vessels constituting our squadron in those Avaters at the begin- 
ning of the summer, but one escaped its attacks. 

During the year there occurred in all throughout the squad- 
ron thirty-one cases of yellow fever,* exclusive of those on the 
Saratoga, with seven deaths, being a percentage of deaths to 
cases of .22, or one death to every 4.43 cases. 

The Saratoga, first visited, suffered the most, both in number 
of cases and in their malignancy, the percentage of deaths in 
the thirty-seven cases being .46, or. 1 death in every 2.17 cases. 

The following table shows the number of cases of yellow and 
remittent fever, respectively, that occurred on each of the 
vessels of the West India squadron during the year 1869, as 
reported: 



REMITTENT FEVER. 



Cases. Deaths. 



YELLOW I-EVEIL 



Cases. Deaths. 



Albany 

Tantio 

iNarragansett. 
Gettysburg... 

Penobscot 

Saratoga 



Total. 



* La Koche, in his work on yellow lever, vol. i, p. o33, gives statistics of 
epidemics on twenty vessels, in tropical regions, gathered from published 
accounts, which give an average of 1 death to every 3.46 cases. 



174 MEDICAL AND SURGICAL ESSAYS. 

There can be little doubt but that some cases, which were essen- 
tially identical with those reported as yellow fever, but which 
did not progress to a fatal termination, and did not manifest the 
worst phenomena of that disease, especially at the first ap- 
pearance of the disease, before its true nature was recog- 
nized, were called and reported as cases of remittent fever. 
If - so, and these cases could be placed in the proper column, 
the number of cases of yellow fever that really occurred in 
the squadron would be much increased, while the death rate, 
as compared with the cases in general, would be diminished. 
However, the figures as reported render sufficiently prominent 
the exceptional severity of the disease, as manifested on the 
Saratoga. 

No reason why the disease should have appeared sooner, and 
in a more malignant form, on board the Saratoga than on board 
her consorts, can be found in the condition of the ship itself; 
which, on the contrary, was such as would tend to render it the 
least liable to become infected, and which afforded surroundings 
the best adapted to the care and favorable progress, of such as 
should be attacked, should disease make its appearance. She 
was roomy and comfortable, well ventilated and lighted, and a 
model of neatness and cleanliness throughout. The morale of 
the ship's company was excellent, and its general health un- 
usually good. For six weeks previous to the appearance of the 
first case of yellow fever, there had not been a single case of 
sickness on board, even of the most trivial character. But 
though the ship itself was in this excellent condition, the cir- 
cumstances in which it was placed were such as by their com- 
bination could not but be potent agencies in the production of 
the results in question. These were the season of the year and 
the non-acclimation of the ship's company, and the special evil 
influences pertaining to the harbor of Havana, and particularly 
to that part of it in which the ship was anchored. 

In the latter part of May begins in Havana the so-called 
unhealthy season, which extends through the summer and into 
the fall, to the last of November. At the very beginning of 
this season the Saratoga arrived from the north with a crew 
entirely unacclimated, a time when the general climatic influ- 
ences, at all times unfavorable to the unacclimated, tended most 
to the production of the special diseases incident to them. The 
harbor of Havana is a land-locked bay, surrounded on all 
sides by hills, except at a point on its northern aspect, where 



3IEDICAL and surgical essays. 173 

it communicates with the sea by a narrow channel. Its north- 
eastern boundary is a narrow peninsula, less elevated at its 
junction with the mainland than in the rest of its course, per- 
mitting the prevailing easterly breezes to reach the harbor. 
The usual rise and fall of the tide in the harbor is very slight, 
while the only communication between the bay and the sea is 
narrow and somewhat tortuous ; these conditions cause the har- 
bor to assimilate in character to a great stagnant pool. The 
bay receives the water shed from the surrounding hills, the 
drainings from the village of Eegla, on its southern shore, and 
the contents of most of the sewers of the city of Havana. 
From the shipping with which it is crowded during the greater 
part of the year, it receives additional filth. These causes ren- 
der its water very foul, and its stagnation favors the putrefac- 
tion of the filth which it contains, which process is hastened 
and aggravated by the uniformly high temperature at which 
the. water is kept by the conjoiued influence of the Gulf Stream 
and the tropical sun. The effects of this are somewhat coun- 
teracted, during the so-called healthy or dry season, by the con- 
stant sea-breezes prevailing, and by the dryness of the atmos- 
phere, but during the remainder of the year, when the sea- 
breezes fail, and at times are replaced by debilitating land- 
breezes, when the atmosphere is saturated with moisture, an 
opposite result obtains ; the air becomes laden with the pro- 
ducts of decomposition, and a high degree of virulency favored 
in their effects. The Saratoga, arriving at the beginning of this 
latter season, was anchored on the west side of the harbor, 
within a stone's throw of the quay lining the shore, and in close 
proximity to the track of a line of ferry-boats. The sea-breeze 
could reach her only after passing over the whole bay, becom- 
ing necessarily laden with its exhalations. The constant 
superficial agitation of the water in the immediate neighbor- 
hood of the ship by the ferry-boats favored, in an eminent 
degree, the rapid decomposition of the already putrescent mat- 
ter contained in it, and the disengagement of the noxious effluvia 
resulting. In this position, without shifting her anchorage, the 
ship remained from May 10th to June 7th, when she put to sea, 
stricken with yellow fever. Three cases occurred nearly simul- 
taneously ; two on the 2d of June, those of Surgeon Quinn and 
Lieutenant Lamberton, and one on the 3d, that of Private 
Bowler. No further cases occurred till June 7th, when two more 
persons were attacked. Of these three cases, occurring nearly 



170 MEDICAL AND SUEGICAL ESSAYS. 

simultaneously, the habits, circumstances, and relations of each 
differed greatly, agreeing only in the one point, that they were 
all equally exposed to the general evil influences pervading and 
surrounding the ship, already named. Her two consorts, the 
Albany and the Penobscot, were anchored in another part of 
the harbor, and both escaped untouched by the disease at this 
time, unless the febrile cases, mentioned as having occurred on 
the Penobscot, be considered as essentially identical with those 
on the Saratoga, though milder in degree. All the cases that 
occurred cu the Saratoga, thirty-seven in number, are exhibited 
in the following general tabulated statement : 



MEDICAL AND SURGICAL ESSAYS. 



177 



O* ^ _: 



a 

Ph 


Partial .suppression of urine, convulsions, 
Coma. No black vomit. 

Urine for a time very scanty, albuminous, 
highly colored, containing bile pigment. 

Died comatose Black vomit one hour 
before death. 

Convalesced from the third day. 

Convalesced from the fourth day. 

Convalesced from the third day. 

Black vomit on last day. 

Epistaxis on third day. Black vomit on 
fourth day. 

Epistaxis. Black vomit. Long and tedi- 
ous convalescence. 

Condition precarious for some time. < Ion- 
valescenee tedious. 

Mulatto. Epistaxis. Black vomit. 

Experienced pain only on left Bide oi 
head and body. 

Convalesced from flic third day. 

Urine albuminous. Black vomit. 

Deficient in intellect. Delirious from (lie 
first. Particulars of death not ascer- 
tained. 


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MEDICAL AND SURGICAL ESSAYS. 



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MEDICAL AND SURGICAL ESSAYS. 179 

An examination of these cases gives the following: 



Total number of— 


o 

u « 


o £ 


Officers 


is 

105 
78 
24 

225 


77 
9 
9 

ie 


50 
33 
29 
83 

46 













Earliest period of death, third day; latest period of death, 
tenth day; average period of death, fifth day. 

Black vomit occurred in 11 cases ; recovery after black vomit 
in 1 case ; epistaxis noted in 5 cases ; recovery after epistaxis 
in 1 case; particulars unascertained in 2 cases. 

From the time that the ship left Havana until the evening of 
the 13th, a space of six days, no new cases occiirred. During 
this time there was a succession of days of fine weather; a gen- 
tle breeze from the northeast prevailed. All the hatches and 
air-ports were kept open. Those already ill progressed favor- 
ably, and the hope was entertained that the disease had been 
checked. A new case in the evening of the 13th, and two more 
the next morning, reawakened apprehension. During the after- 
noon of the 11th the weather experienced a rapid change, be- 
coming cold and stormy, with rain and wind. This continued 
through the night and the next day, necessitating the closing 
of the hatches, thus rendering the air of the vessel close and 
bad, while, at the same time, much necessary exposure to the 
inclemencies of the weather resulted to the officers and men. 
Although the ship made north of Cape Hatteras on the 15th, 
and the weather again became fine, with cool and refreshing 
breezes, the rapid extension of the disease dates from that day. 
Six cases on the loth, one on the 16th, four on the 17th, three 
on the 18th, two on the 19th, and three on the 20th successively 
appeared. Of these, two died before reaching New York, while 
a third, Lieutenant Flagg, expired just before the ship came to 
anchor. In many of these cases, in addition to the general 
influences, acting as predisposing and efficient causes, it was 
possible to trace special exciting causes which determined the 
attack. Thus, in one case, an officer, while perspiring freely, 
became chilled by sitting in a draught of air. Four hours after, 
the fever -was fully developed. Another, returning from the 
deck with his clothing wet with rain, neglected to remove it at 



180 3IEDICAL AND SURGICAL ESSAYS. 

once, sittiug down for some time in bis damp garments; an attack 
of the disease followed almost immediately. Another, after the 
arrival of the ship at Sew York, indulged once in liquor to in- 
toxication. His debauch left him laboring under the fever, which 
resulted iu his death. In the last case that occurred, that of the 
boy Pratt, on the Frolic, five days after the transfer from the 
infected vessel, he had lain down to sleep in a gangway of the ves- 
sel, where he became chilled through during the night. As a re- 
sult, there followed a typical case of yellow fever, the stages well 
defined, and the icterus attending convalescencevery. marked. 

Of the large number of cases which occurred on the 21st, 
seven in all, in most particular causes of similar nature to those 
already given, can be traced, to which they may be referred. 
The large number of cases occurring on that day, and their • 
almost complete cessation from that- time, is somewhat remark- 
able, and seems to indicate the utility of the measures for dis- 
infection which were adopted, and" especially to be due to the 
speedy removal of the men from the infected ship to one free 
from such taint. Iu the circumstances attending the cases of 
yellow fever on this vessel, there were none which indicated 
that the disease was in any way propagated by contact with 
the sick, or by exposure to the emanations or secretions from 
their bodies. On the contrary, those who were most about the 
persons of the sick escaped entirely. 

The apothecary and four nurses, all uuacclimated and unpro- 
tected by a previous attack of the disease, who were with the 
sick continually, night and day, and, in some cases, unavoidably 
received upon their persons matters vomited by the dying, were 
none of them attacked. 

Commander Whiting, who filled his cabin with the sick offi- 
cers, and who was constantly among all the sick, encouraging 
them by cheerful words and aiding them by his attentions, was 
one of the two commissioned officers on board the vessel who 
alone escaped the disease. 

The medical officer received from the Penobscot was able to 
resist the disease till after the arrival of the vessel at New 
York, when, consequent upon exposure for some time to the 
hot sun in passing from the Saratoga to the Illinois, and upon 
unusual exertion in superintending the removal of certain of 
the sick, and upon reaction from the mental strain of the pre- 
ceding two weeks by the transfer of all care to others, he was 
attacked, the circumstances giving no support to any theory 
of contagiousness in the disease. • 



MEDICAL AND SURGICAL ESSAYS. 



181 



This officer was succeeded by Surgeon II. JVI. Wells, tempo- 
rarily detached from tlie New York Naval Hospital, who, trans- 
ferred with the rest from the Saratoga to the Frolic, remained 
until their release from quarantine. During this time he spent 
much of each day on board the hospital hulk with the sick, 
being assiduous in his attentions to them, without contract- 
ing the disease. Further, notwithstanding the number of the 
sick transferred to the Illinois, not one of the quarantine offi- 
cials or attendants was attacked by the disease. In the trans- 
fer of the sick special care was taken to prevent as much as 
possible any articles from accompanying them which might act 
as fomites. 

Upon the arrival of the ship at quarantine active measures 
were adopted for disinfection. Carbolic acid was poured down 
the pumps, and introduced into the bilge at other points. Car- 
bolated lime was strewn about the decks, and chlorine gas was 
liberated by the common salt mixture throughout the ship, the 
hatches being closed. During the summer following the latter 
measure was repeated several times, and in the intervals the 
most thorough ventilation secured. 

Throughout the course of the epidemic, in the cases that 
occurred, there was absent any sthenic action, no furious deli- 
rium, no raging heat of the skin, no strong, full arterial pulsa- 
tions. In but few cases did any delirium occur, and then it was 
low and muttering in its character. The skin from the first, in 
the majority of cases, was warm and moist, and the pulse, 
though at the outset of the attack in most it was very frequent, 
yet was always weak and soft in character. Its variations and 
characteristics in the different cases were found to be valueless 
as an indication of the intensity or the tendency of the attack. 

The following table exhibits its frequency from day to day 
in ten cases: 





Pulsations pei 


minute. 




Names. 


-5 


■a 

CI 


>, 


a 


g 


Result of ease. 


Quick 


112 
90 
100 
112 
96 
120 
96 
120 
130 
101 


98 
76 

no 

;m 

72 
88 
60 
92 
88 
100 


66 
76 
92 

84 
60 
88 
60 
88 
92 
88 


611 
68 
92 
92 
68 
58 


72 
76 
100 

76 

61 






Death on night of fifth day. 


Riley 


Do. 




Recovery. 




Do. 




Death on niuth day. 







































182 3IEDICAL AND SURGICAL ESSAYS. 

Complete suppression of urine occurred in no case. In the 
majority of cases, even of those terminating fatally, its secretion 
remained free. The nearest approach to suppression was in 
the case of Sergeant Quinn, the symptoms attending -whose 
death indicated uraemic poisoning. In other cases the urine, 
though free, was highly athemious, a condition which super- 
vened in such of those cases which were at all prolonged, 
whether eventuating in death or recovery, as were under the ob- 
servation of the writer. In the cases which were treated wholly 
on board the quarantine hospital hulk, no examinations of the 
urine, as to the presence of albumen, were made. The condi- 
tion of the bowels presented no features worthy of note. More 
or less constipation was present at the outset of many of the 
cases, relieved by gentle cathartics in all cases. The tongue, at 
the outset, was covered with moist white fur, in some cases 
presented a punctated appearance, afterward changing in its 
appearance as the disease progressed, either gradually clearing 
off, or becoming dry, and brown or black, and in some cases 
clearing off rapidly, presenting then a raw appearance, as if 
entirely denuded of its epithelium. In the three cases which 
terminated fatally, during the passage from Key West to New 
York, death was heralded in each case by this latter condition 
of the tongue, the denudation beginning first at the edges, on 
each side, and thence spreading over the whole tongue. In the 
last of these cases, in Avhich life was prolonged to the sixth day, 
the dorsum of the tongue became dry, black, and scaly during 
the last day. 

Apparent heat of the head, out of proportion to that of the 
body in general, was noticed in every case. This persisted for 
some ti me after all other symptoms ameliorated. Its subsidence 
was regarded as an unerring indication of the establishment 
of convalescence. 

Intense frontal or orbital headache, described as passing 
from temple to temple through the eyes, with infection and 
suffusion of the conjunctiva, was a constant symptom attending 
the beginning of an attack. Pain in the'back was also usually 
great. In one case, pain in the calves of the legs was bitterly 
complained of. In one case, pain was experienced in the left 
temple and in the left side of the body only. Tenderness of 
the epigastrium and a peculiar sensation of fullness at that 
point, especially on deep inspiration, was usual. 

The most prominent and distressing symptom was gastric 



MEDICAL AND SURGICAL ESSAYS. 183 

irritability. In some cases, despite the careful avoidance of all 
irritation, uncontrollable vomiting persisted through the first 
stage of the disease. In these, after a short calm, in nearly 
every instance, the vomiting again recurred, soon presenting 
the peculiar appearance termed black vomit. 

In the greater number of cases, however, after one or two 
paroxysms of vomiting when first seized, though the irritability 
of the stomach remained great, it was repressed by the meas- 
ures adopted, the slightest indiscretion, however, again provok- 
ing vomiting. After the period of calm following the subsidence 
of the symptoms attending the febrile paroxysm — in many of 
these latter also — vomiting then appeared spontaneously, en ding- 
in black vomit and death. Much thirst was complained of in 
most of the cases. 

The general measures of treatment adopted on board the 
Saratoga were directed toward supporting the system, and aid- 
ing it in its efforts to eliminate the poison with which it was 
saturated. Special symptoms it was endeavored ' to meet as 
occasion required. 

The treatment as continued on board the hospital hulk, after 
the transfer of the cases thither, was essentially the same. All 
internal remedies of a depressing character were avoided ; 
indeed, the irritability of the stomach universally precluded 
the administration of any internal remedy, even had such been 
deemed advisable. The .most accessible point was the skin, the 
action of which it was endeavored to sustain and promote by 
wrapping the patient in blankets wrung out in hot water — as a 
substitute for the hot bath, which the want of a bath-tub pre- 
vented from being adopted — and by sponging the skin, from 
time to time, with tepid water and vinegar. At the earliest 
possible moment, food and stimulants were methodically admin- 
istered according to the condition of the patient. 

In the whole course of the epidemic, the most prominent 
symptom which presented itself was the extreme 'irritability of 
the stomach ; the local measures of treatment adopted were 
chiefly directed toward this, to prevent its occurrence if possi- 
ble, and to lessen its severity when present. A careful avoid- 
ance of every source of irritation, whether medicinal or aliment- 
ary, was insisted upon ; counter-irritation, by sinapisms to the 
epigastrium, was effected when occasion seemed to demand ; 
pellets of ice were allowed to melt in the mouth, for the double 
purpose of controlling gastric irritability and of alleviating 



184 MEDICAL A]S T D SURGICAL ESSAYS. 

thirst ; nothing but fluids, and those in very small quantities 
often repeated, were administered. These were the measures 
that were found to be most effectual in preventing and alleviat- 
ing this symptom. In addition, various medicaments, as car- 
bolic acid, turpentine, aromatic spirits of ammonia, the effer- 
vescing draught, and others, were used in most of those cases 
in which the measures first mentioned did not prove sufficient, 
but without decided benefit. 

Frontal headache, invariably great, was alleviated by cold 
applications to the forehead and temples. Pain in the back, 
much conrplained of, by sinapisms and cuppings. 

The importance of avoiding carefully any unusual exposure 
or fatigue, or irregularities of diet, or the giving way to excess- 
ive anxiety, and of preserving the general condition of the 
body in the most perfect health j)ossible, as prophylactic meas- 
ures, was plainly shown by the circumstances which seemed to 
determine the attack in many instances, some of which have 
been mentioned. 

In a number of instances in which men presented them- 
selves at once upon the first appearance of those symptoms 
which usually marked the onset of the disease, as chills, heat 
of head, intense frontal headache, and fever, with very frequent 
pulse and furred tongue, from fifteen to twenty grains of qui- 
nine were given immediately. In a short time complete relief 
was experienced, with no recurrence of the symptoms. 

Whether this result was a mere coincidence or an effect, can- 
not be said, yet the impression grew continually stronger that it 
was the effect of the quinine administered, as although in all cases 
the result was not so favorable, yet, in no cases presenting the 
same symptoms, in which quinine, as stated, was not adminis- 
tered at once, did the disease fail to continue and to pass 
through its usual course. 



SANITARY CONDITION OF THE UNITED STATES ASIATIC SQUADRON, 

DURING THE PERIOD OF TWO YEARS, FROM APRIL 

1, 1868, TO MARCH 31, 1870. 



The influence of climate on the health and mortality of man 
in different portions of the globe is becoming more and more 
a subject of interest to scientific as well as practical medicine, 
now that we can be whirled around the earth's surface, with 
comparative comfort, in the short period of ninety days. 

Places hitherto remote are now of easy access. Japan was 
almost a terra incognita a few years since, and a voyage to China 
was thought to be a great undertaking. But now these countries 
seem to be brought to our very doors, by means of the Pacific 
Pail way and the Pacific Mail Company's splendid steamers. 
This facility of transit swells the tide of travel, either for busi- 
ness or pleasure ; hence the influence of this change of locality, 
upon those who wander from their homes, is a matter of pecu- 
liar interest at the present time. . 

The limits of the Asiatic squadron extend from the Equator 
to about 42° of north latitude. Within these lines we have the 
whole of the northern tropical and a greater portion of the 
northern temperate zones. The first of these, styled by Alex- 
ander Keith Johnson the tropical disease realm, is character- 
ized by great atmosphericheat and humidity ; and the prevailing- 
diseases are dysentery, diarrhoea, cholera, hepatic affections, 
and malarial fevers. 

That portion of the station north of this, included in the 
temperate zone, extending along the coast of China, is charac- 
terized by the same diseases during the summer and autumn 
months, while in winter, typhus fever, pulmonary affections, 
and rheumatism prevail. The islands forming the Japanese 
Empire, having an exceptional climate, will be considered fur- 
ther on. 

The squadron for a greater part of the time was composed of 
ten ships, with an average force of fifteen hundred men ; and 
the following table will show the classes of disease, sickness, 
and mortality, during the period indicated: 



186 



MEDICAL AND STJEGICAL ESSAYS. 



Table showing the classes of disease and number of admissions 
and deaths in the Asiatic squadron for two years, from the 1st 
of April, 1868, to the 31st of March, 1870, in a force of fifteen 
hundred men. 



Febrile or miasmatic 

Digestive 

Eespiratory 

Circulatory 

Nervous 

Integumentary 

Fibrous and osseous 

Exhalants and absorbents. 

Genito-urinary 

Entbetic * 

Cachexia? 

Eye and ear 

Injuries, accidents 



Total. 



1« 



*In addition to the above there were over six hundred persons treated for venereal 
diseaes, who were not excused from duty. 

From the above table, the sickness is represented by three 
thousand six hundred and ninety-three admissions, and the 
mortality by seventeen deaths.* Of the latter, six were from 
accidents, one from typhoid fever, two from small-pox, two 
from dysentery, two from pulmonary diseases, two from cardiac 
affections, and two from diseases of the nervous system. This 
is a remarkably small mortality for this station ; especially so 
as regards intestinal and malarial fevers. There were eight 
hundred and twenty admissions for dysentery and diarrhoea, 
with only two deaths ; yet a few years ago these diseases were 
the scourge of the East, very few of our ships escaping a severe 
visitation from them during some period of the cruise. 

It will naturally be asked, why this great reduction of sick- 
ness and mortality in a region hitherto considered so unhealthy? 

* Four deaths are reported among those who were invalided home during 
the two years. 



MEDICAL AXD SURGICAL ESSAYS. 187 

The answer is, the adoption of a better system of hygiene, both 
afloat and ashore, an ample supply of pure drinking water, a 
better diet for the men, a more enlightened method of medical 
treatment, and, finally, the opening of Japan, offering facilities 
for a change of climate. 

Until recently the supply of water on the China coast having 
been taken from rivers in the vicinity of filthy towns and cities, 
or from streams flowing through rice-fields,* was vitiated by 
decayed animal and vegetable matter, and hence the exciting 
cause of intestinal affections. and malarial fevers. But there is 
a great improvement in this respect ; at many points we find 
abundance of good water at present. This is especially the 
case at Hong-Kong, where immense stone reservoirs have been 
constructed, which are filled from pure mountain streams, 
affording an ample supply for every demand. 

At Shanghai, also, where the river water is extremely un- 
wholesome, excellent water is now brought from a lake, some 
miles above the native city, for the supply of the foreign settle- 
ment and shipping. At other points on the coast, where the 
water is impure, the distilling apparatus now attached to all 
steam- vessels is called into use ; therefore this fruitful cause of 
disease is obviated. 

The allowance of fresh meat and vegetables several times 
during the week, or even daily, if deemed necessary in the 
hottest weather, tends to maintain a better condition of the 
system, and render it less liable to disease. 

Attention to drainage, and an improved method of construct- 
ing houses in the English towns and European settlements, 
have also greatly improved their sanitary condition ; and our 
ships have been greatly benefited by the custom of shellacing 
the berth-deck, thereby avoiding dampness, as well as by a 
greater attention to the cleanliness of the hold and bilges.t 

At Hong-Kong, where the range of the thermometer is from 
•45° to 99° of Fahrenheit, with heavy rain-falls from May to 
August, and subject to great changes of temperature during 
the winter months, the mortality from fever and dysentery was 
formerly excessive. 

* In both China and Japan human excrement is carefully preserved and 
returned to the soil. 

tAn improved arrangement of tbe holds of our ships is greatly needed. 
{Vide communication No. 0, series 1868, to the Chief of Bureau Medicine and 

Surgery.) 



18S MEDICAL AND SURGICAL ESSAYS. 

The troops, especially, suffered severely, owing to their being 
quartered in poorly constructed frame barracks, and sleeping 
upon the ground floor. But .since the erection of new buildings, 
which are of stone, well ventilated, well drained, with the 
sleeping apartments raised one story from the ground, they 
eujoy a comparative immunity from disease. In this connec- 
tion I must mention that venereal diseases are less virulent and 
much less prevalent at this place than formerly, owing to a 
strict system of registration and inspection of all public women. 
The average number of sick in the English barracks has been 
reduced one-third by this measure. We have also reaped the 
benefit of it ourselves, for after a liberty of forty-eight hours 
given to one of the ships of the squadron, with a crew of nearly 
five hundred men, only six cases of chancroid were returned. 

The low-lying site of Shanghai, scarcely raised above the 
level of the Woosung Eiver, and exposed to marshy exhalations, 
will always render it an unhealthy place of residence ; yet even 
here there has been a great decrease in sickness and mortality, 
with improved drainage, and greater personal care as regards 
diet and exposure to the sun during the hot season. Ships 
obliged to remain here throughout the summer should take a 
short trip to sea every two or three weeks. This is the plan 
pursued by the English, who are very careful of the health of 
their men. 

In regard to the treatment of tropical dysentery, once the 
most formidable disease in the East, a wonderful change has 
taken place. In our day, a disciple of Todd thrills with holy 
horror as he reads the general rules recommended by Sir James 
McGregor, for adoption in the army, during the peninsular war, 
or those more recently advised by Sir Eanald Martin. These 
consisted mainly in calomel and blood-letting, the latter, accord- 
ing to Sir James McGregor, to be repeated until the stools were 
free, or nearly free, from blood. Depletion, either general or 
local, and the mercurial treatment advised by Dr. Johnson, are 
now, happily, things of the past, at least amoug the most enlight- 
ened practitioners. The object now is to husband the strength 
of the patient, however acute may be the symptoms under this 
depressing disease. Since the adoption of a more conservative 
treatment, the mortality from dysentery in India has been 
reduced from 7.1 per cent, to 1.3 per cent., and the record of 
the squadron only shows two deaths from that disease in the 
two years. 



MEDICAL AND SURGICAL ESSAYS. 189 

I come, now, to the islands of the Japanese* Empire. Lying 
between the thirtieth and fortieth parallels of north latitude, 
they possess one of the most salubrious climates in the world, 
and are properly styled the sanitarium of this portion of the 
East. 

At Yokohama, latitude 35° 2G' north, situated within eight- 
een miles of Yeddo, and the headquarters of all the foreign 
squadrons, the mean annual temperature is 59° Fahrenheit. 
Minimum, 48°; maximum, 92°. The most disagreeable feature 
of the climate is the heavy rains from April to August. The 
average rain-fall is about fifty inches, annually; but during the 
year 1SGS-69 — rendered remarkable throughout the world for its 
meteorological phenomena — it rose to one hundred and twenty 
inches. Excellent water, from mountain streams, can be pro- 
cured at the principal ports of Japan, yet the necessity for a 
high standard is not so important as in China, owing to the 
infrequency of intestinal affections. 

Malarial fevers, as far as my observation goes, are rare, even 
among the rural population, who dwell amid their damp rice- 
fields. The most prevalent diseases are rheumatism, typhus 
fever, small-pox, syphilis, ophthalmia, and cutaneous affections. 

Typhus fever and small-pox need be feared only during the 
cold, damp weather of winter and spring. The Japanese having 
no means of heating their houses shut them up* closely in cold 
weather, to keep warm. They generally overcrowd them, and 
have no appliance for ventilation. This, together with bad 
drainage and defective sewerage, is no doubt the exciting cause 
of fever in their cities. 

Cutaneous diseases are exceedingly common among them, 
and especially scabies, which is of the mOst inveterate kind, 
often lasting during a lifetime. In cases of long standing it 
becomes pustular and scaly, and the sufferer presents a dis- 
gusting appearance, being sometimes literally covered with 
sores and scabs. This is among the poorer classes, however, 
who rarely, if ever, chauge their clothing. The Japanese are 
described as a cleanly people, and as far as the use of the bath 
is concerned this is true. Bathing-houses are seen all over 
their cities, filled with bathers of both sexes, who enjoy, pro- 
miscuously, their hot bath. But they do not change their 
garments. In fact, they think it very strange that foreigners 
find it so necessary. An American physician, who has resided 



*Ni-pou — ni sui), a. yon source. 



190 MEDICAL AND SURGICAL ESSAYS. 

for many years in the country, told me lie was once traveling 
in company with a Japanese doctor who said to him, "It must 
be a great inconvenience to you foreigners to be always changing 
your clothes. I have worn these I have on for six months, and 
still they do- not smell badly !" 

The most formidable enemy we have to contend with in the 
shape of disease is syphilis. This prevails to a frightful extent, 
and in its most virulent form. The true chancre is vastly more 
common than it is either in Europe or America, and the sec- 
ondary manifestations are usually very severe. Gonorrhoea is 
also very intractable, and notwithstanding every precaution, 
epididymitis is a frequent complication. 

Even vice is systematized in Japan. The government not 
only sanctions, by license, houses of prostitution, but derives a 
direct revenue from this source. A quarter in every town and 
city of the empire is inclosed and set apart for purposes of 
debauchery, which is covered by no veil of mystery as in other 
lands. 

In the city of Yeddo there is a large district devoted to the 
courtesans, called the Yoshi-wara. This is laid out in broad 
avenues, planted with pine shade-trees, ornamented with beau- 
tiful gardens, and contains some of the finest buildings in the 
capital,, next to the daimio's palaces. This region is presided 
over by a chief, whose headquarters is the grankiro, a species 
of cassino, fitted up in splendid style, for the amusement of the 
higher classes of the Yoshi-wara, and used for banquets, 
dancing, concerts, theatrical exhibitions, &c. The chief of the 
grankiro gathers recruits for his establishments by purchasing 
young girls from seven to eight years of age, of indigent 
parents, who are unable to maintain a large family. Their first 
years are spent in acquiring an education, the older girls 
instructing the younger in music, singing, dancing, embroidery, 
&c, and many of them become famed for their accomplish- 
ments. When a girl is grown up, her master is ready to part 
with her if he receives a good offer ; if not, she remains attached 
to one of the houses. It is said not to be an uncommon occur- 
rence for a man to choose a wife* from among these courtesans. 
The fact of a girl having been brought up in that capacity 
does not operate unfavorably against her in a social point of 
view, the fault being charged to her parents, who sold her in 
childhood. 

* This lias been denied by Aime Humbert. ( Vide Japon Illustre, 1870.) 



MEDICAL AND SURGICAL ESSAYS. 191 

During the past year Admiral Sir Harry Keppel, then com- 
manding- the English fleet on this station, detailed a naval sur- 
geon, with tlie consent of the Japanese government, to open a 
hospital at Yokohama, in the quarter set apart for courtesans, 
with the view of instructing native physicians in the use of the 
speculum. It is hardly time to witness any striking results 
from this humaue endeavor to save thoughtless men from the 
consequences of their own folly, yet, from the aptitude of the 
Japanese in adopting everything novel and useful, I think we 
may safely look for a great abatement of the evils of syphilis. 

In conclusion, I will add that, from the observations of phy- 
sicians who have been long resident in Japan, it may now be 
safely stated that it possesses one of the most salubrious cli- 
mates in the world; while, on the other hand, all experience 
proves that the coast of China is remarkable for its unhealthi- 
ness. Yet, even there, a better- acquaintance with the nature 
of the climate, a greater personal care, as regards food, cloth- 
ing, exposure to the sun, &c, &c, enable foreigners, in a great 
measure, to combat its deleterious influences. 
Eespectfully, your obedient servant, 

EOBEET T. MACCOUX,- 

Fleet Surgeon Asiatic Squadron. 



ON DIABETES. 



By James McClelland, M. D., 
Medical Director, V. >S. X. 



Notwithstanding the rapid progress of medical science, the 
pathology of diabetes is still involved in obscurity. Even the 
seat of the disorder is yet a point of controversy. It is true 
that physiology has shed much light upon the phenomena of 
glycogeuesis, that chemistry has explained to us the peculiar 
nature of the discharge, and anatomy demonstrated a few morbid 
changes, but neither these, nor the labors of Prout, Pavy, Ber- 
nard, Sckiff, and others, have thrown enough light upon the 
subject to lead to a satisfactory conclusion. Among ancient 
writers, diabetes inellitus was regarded as a urinary disorder, 
having its seat primarily and idiopathically in the kidneys. 
They likened it to Uentery, from the excessive destruction of 
tissues, and the rapidity with which the solids and fluids of the 
body were hurried forward to the kidneys; and this view of 
Galen's* was adopted without much change by Aretaeus and Tral- 
lian. The same doctrine was supported by Euysch, Dupuytren, 
Thenard, Henry, and Satterley, but they associated with the renal 
mischief some secondary or sympathetic derangement of the 
chylifacient viscera. Willis, Sydendam, Place, Latham, and 
some others, regarded it as a " dyscrasy or intemperament of the 
blood produced by a morbid action of the assimilating powers." 
Nearly a century ago, Darwin,t in his ingenious essay, argued 
that " the disease is dependent upon a retrograde motion of the 
lacteals, and is consequently seated in the lacteal vessels." But 
this hypothesis, plausible as it was, found few supporters. Even 
Frank, $ who at first accepted it, gave up the doctrine of a retro- 
grade motion, but still believed that the disease had its seat in 
the lymphatic system. And so we find the stomach, or some 
of the chylifactive organs, the blood, the lacteals, and the kid- 

* Galen, De Crisibus, lib. 1, cap. xii ; De Loc. Affect., lib. vi, cap. iii. 

t Darwin, Prize Essay, 1778. 

i Frank, De Cur. Horn. Morb. Epit., torn, v, pp. 54-57. 



3IEDICAL AND SURGICAL ESSAYS. 193 

neys, have each in turn been the field for speculation concern- 
ing the nature of this disorder. For years the weight of authority 
was in favor of some lesion of the digestive organs, and was 
doubtless strengthened by Eollo, who fixed the seat of the disease 
in the stomach, believing it to consist " in an increased action 
and secretion with a vitiation of the gastric fluid, and probably 
too active a state of the lacteal absorbents ; while the kidneys 
and other parts of the system, as the head and skin, are only 
affected secondarily." This hypothesis, which supposes the 
blood to be formed imperfectly from the first, and the morbid 
change of animal salts for sugar to be the work of the stomach 
or its auxiliary organs, was combated by Latham, who believed 
the stomach, as well as the kidneys, to be perfectly sound. Some 
recent writers regard the liver as the fons et origo mail Pavy 
inferred from experiments made in conjunction with Dr. Owen 
Bees, that the morbid condition in diabetes is not the want of 
decomposing power in the lungs, nor the over-production of 
sugar in the liver, but in the formation in this organ of glucose, 
instead of true hepatic sugar. Andral supposes it is due to an 
abnormal activity in the sugar-forming function produced by 
hepatic congestion, and Roberts believes it " consistsproximately 
in some disturbance of the destiny and functions of the amyloid 
substance of the liver." Dr. Bence Jones advances the theory 
that diabetes may arise from deficient oxidation of the non- 
nitrogenous compounds, and Dr. B. H. Uoates, of Philadel- 
phia, suggests that it may be caused by an original defective 
formation in the organs of digestion ; analogous to dwarfishness, 
deficiency, or malformation of the limbs, excessive thinnes.s 
or obesity. As early as 1692 Camerarius* conceived diabetes 
to be a nervous affection, and looked upon the pains in the 
loins, and the excessive discharge of limpid urine, as analogous 
to symptoms in hysteria. In 17S5, Cullen adopted this view, 
and classed the disease among the neuroses ; but he does not 
seem to have been quite satisfied with his reasons for so doing, 
for in one of his aphorism st he says: "In most cases, the 
proximate cause is some fault in the assimilatory powers, or 
those employed in converting alimentary matter into the proper 
animal fluids." Recent physiological investigations having 
somewhat confirmed the views of Camerarius, it is not unlikely 
that we shall find diabetes again regarded as a disease of the 

* Diss, de Diabete Hypochondriacorum Periodico, 1696. 
t Cullen, Pract. of Phys., Apb. MDXII. 
13 31 



19-i MEDICAL AND SURGICAL ESSAYS. 

nervous system. It is well known that the inhalation of chlo- 
roform, ether, nitrous oxide, and other gasses have been fol- 
lowed by the presence of sugar in the urine. Irritation of the 
cranial nerves has produced it, and pregnancy, diseases of the 
respiratory organs, intemperance in eating and drinking, have 
done the same. Eej T nosa states that he found the urine sac- 
charine after the use of narcotics, quinia, mercury, and other 
drugs. But these are cases of incidental glycosuria. Many 
late writers seem disposed to regard the disorder as of nervous 
origin, and ceitainly as much can be said in favor of this hy- 
pothesis as of any other. Becquerel* noticed it as the result 
of cerebral and spinal lesions. Boberts traced it in several 
cases to mental emotions. Landouzy saw it brought on by 
violent grief; and Bayer mentions a case as coming on after a 
violent fit of anger. Various diseases and injuries of the brain 
and spinal cord are mentioned by Bavy, Fritz, Gooldeu, Fischer, 
and others, as exciting causes. Boberts, though he believes 
that the disease " consists proximately in some disturbance of 
the destiny and functions of the amyloid substance of the 
liver,"t acknowledges that "this disturbance may be due origi- 
nally to disease far away from the liver itself, in some part of 
the sympathetic chain which controls this function." LuysJ 
audMonneret§ found serious pathological changes in the fourth 
ventricle. Tardien|| records a case in which the medulla oblon- 
gata was found congested ; and Bichardson one in which, after 
death, an ossiflc growth was found pressing upon the pons 
varolii, and an abscess in the posterior cerebral lobes. Schiff, 
Bernard, and Bavy produced diabetes artificially by punctur- 
ing various parts of the nerve centers and organic nerves, as 
the floor of the fourth ventricle, between the origin of the au- 
ditory nerves, at the point of origin of the brachial nerves and 
the spinal cord opposite the second dorsal vertebra. The lat- 
ter experiment on rats produced permanent glycosuria. In a 
very able paper read before the Xew York Academy of Medi- 
cine, February 2, 1871, Dr. Gouverneur M. Smith, of that city, 
defined diabetes mellitus to be " a disease of the nervous sys- 
tem, depending either upon centric or upon eccentric disturb- 

* Brit, and For. Med. CMr. Rev., 1858, p. 199. 

t Urinary and Renal Diseases,'p. 192. 

\ Bulletin de la Soc. de Bibliog., 1860. 

$ Gaz. d. H6p. Jan. 11, 1862. 

|| Eed.Times and Gaz., Feb., 1862. 



MEDICAL AND SURGICAL ESSAYS. 195 

since; by centric, implying- cerebral lesion ; by eccentric, refer- 
ring- to peripheral irritation transmitted to the brain, and re- 
flected either to the liver or other parts, inducing the formation 
of sugar, and likewise generally reflected to the kidneys, excit- 
ing excessive diureses."* 

Of course this definition is not intended to include every 
form of glycosuria, but it may serve to explain the etiology of 
an important group of cases of which but little is known. 
I shall now pass to the dietetic treatment of this disease 
without pretending to discuss the various remedies which 
have been extolled as curatives ; for, as might be expected 
from the diversity of opinion upon the pathology of diabetes, 
we find equal inconsistency and confusion in its therapeu- 
sia. Sydenham says : " In hoc affectu, uti et in omni diabete 
ex 'quacunque npofaest originem ducat, curativce indications 
ad sanguinem invigorandum corrooorandumque, ac pariter ad 
fluxum urince prceternaturalem restringedum ;"t — that the cura- 
tive indication must be completely directed toward invigorating 
and strengthening the blood, as well as restraining the preter- 
natural flux of urine. And this is about all we can do; but to 
do it effectually, and to restrain or prevent the undue tendency 
to a production of sugar in the system, our dependence will 
have to be upon the materia alimentaria rather than on materia 
medica. The necessity for an animalized diet in the manage- 
ment of diabetes appears to have been early recognized. Willis 
confined his patients chiefly to milk or farinaceous substances, 
while Sydenham directed Spanish wine,J and a diet of beef, 
mutton, and the like, doubtless with the intention of supply- 
ing the deficiency of the animal salts and of counteracting the 
secretion of sugar. Not that an exclusive animal diet will 
entirely prevent the formation of saccharine matter. The 
experiments of McGregor and of Griesinger prove the contrary ; 
but the sugar secreted under a strictly animal diet is so scanty 
that the worst effects of the disorder may be suspended, per- 
haps cured, if its use be persevered in. Unfortunately, how- 
ever, many patients cannot long endure it. There seems to be 
such a natural craving for mixed food, that, vary it as we will, in 
time it will become irksome. To Surgeon General Eollo we are 
indebted for reducing to a-system the dietetic plan of Sydenham 

* New York Med. Record, Mar el), 1871, p. 26. 
t Opera Omnia, epiat. 1, p. 289. 
t Ibid., p. 290 



196 MEDICAL AND SURGICAL ESSAYS. 

and of Homo. He enforced upon his patients an entire abstinence 
from every species of vegetable matter, limiting tbeni to 
flesb alone, and under this treatment the tendency to a secretion 
of saccharine matter is less than under any other regimen save 
that of skimmed milk. The latter has been recently proposed 
by Dr. Arthur Scott Donkin, of the University of Durham, 
though we find a milk diet recommended in this disease by Dr. 
Thomas Willis, of Oxford, nearly two centuries ago. From the 
earliest times milk has been used as a medicine, as well as an 
article of food. Hippocrates, Galen, Celsus, and Dioscorides 
agree in considering it wholesome and nutritious, and of great use 
in many diseases, though Celsus says it is apt to disorder the 
stomach and to produce headache, hypochondria, and flatulence. 
Its praise was not confined to medical men. Pliny* mentions 
the cure of gout by it, in which disease modern authors, Van 
Sweiten and others, fully confirm its efficacy. Marcus Terentius 
Varrot says of it: " Est omnium rerum quas cibi causa capimus 
Uquentium maxime alibile, et id ovillumfi inde caprinum f it is 
the most nourishing of all liquid articles which we take for food ; 
and tbis is the case first with that of sheep, and then of goats. 
Simeon Seth, Euffus, and Paul, of iEgina,§ recommend it highly 
in dysentery and phthisis ; and a host of ifliysicians, from 
Stephens to Karell, of St. Petersburg, laud its virtues as 
a therapeutic agent. Bouchardat, however, (whose great 
experience in diabetes is unquestionable,) doubts its efficacy in 
this disease, and forbids its use. . Boberts also looks upon it as 
a doubtful article of food, though he found one of his diabetic 
patients improve materially under its use. One of the greatest 
advantages of milk is that it is food not too highly concentrated. 
For perfect digestion it seems necessary that the ingesta must 
be of a specific degree of density, for if the food be too fluid or 
too gelatinous the stomach will be equally impeded in its opera- 
tions. The interference of a too highly concentrated aliment 
with the digestive power may account for beef extracts and 
other substances in the highest state of concentrated proving 
useless, and in some cases even injurious ; and may also be the 
reason why milk is so rapidly beneficial in the enfeebled diges- 
tion of diabetes. In it we have a mixture of solid and liquid 

* Hist. Nat., xxviii, p. 38. 

,tDe Re Rustic;!, ii., p. 11. 

t Scaliger's edition De R. R., p. 7, has oviiutm. 

§ Paulus JEgiueta, torn. 1, p. 154. 



MEDICAL AND SURGICAL ESSAYS. 197 

aliment of proper density, which in its dietetic relations may be 
considered as intermediate between animal and vegetable food. 
It contains albuminous, saccharine, and oleaginous matters, 
which, being readily assimilated, quickly supply nutriment to 
the exhausted system, without exciting that degree of vascular 
action which is produced by most animal substances. The con- 
stituents of skimmed milk are, according to Berzelius: — 

Water 928. 75 

Casein, with a trace of butter 28. 00 

Sugar of milk 35. 00 

Hydrochlorate and phosphate of potash 1. 95 

Lactic acid, acetate of potash, and a trace of lactate 

of iron G. 00 

Earthy phosphates .30 

1, 000. 00 

In ass's and mare's milk, the proportion of casein is much 
less, rarely exceeding one and a half per cent. Hence the value 
of cow's and of goat's milk in the treatment of diabetes would 
seem to depend upon their superior richness in casein, which is 
the most highly azotized of all the nutritive proximate princi- 
ples. It is at the expense of this protein compound that the 
organized tissues of the body are built up, though we know 
that for the perfect formation of all the animal tissues albumen 
and fatty matter are essential. To its presence, in a soluble 
form, may be ascribed the rapid and great diminution in the 
quantity of the urine, in from twenty-four hours to three days, as 
noticed by Donkin. Physiological experiments prove that under 
albumen, (and it is said that all the proteinaceous compounds, 
albumen, casein, fibrin, vitellin, legumen, and gluten, are prob- 
ably identical in chemical constitution,*) the whole quantity of 
urine is lessened, the urine becomes more concentrated from the 
relative increase of solids, and the amount of urea and uric acid 
is increased. It is a noticeable fact, however, that under an 
exclusively albuminous diet, too long continued, an injurious 
effect is produced upon the system. Hammond proved, by ex- 
periment upon himself, that, under its use, the weight of the 
body materially declined; that the "water, soluble and the 
whole quantity of inorganic salts of the serum were diminished, 
and the solids, albumen and extractive, increased in quantity. 

* Hammond, Physiolog. Mem., p. 85, 



198 MEDICAL AND SURGICAL, ESSAYS. 

Iii the whole blood there was a diminution of the water, blood 
corpuscles, soluble and total amount of iuorgauic salts and fat, 
while there wa^ an augmentation of the solids, fibrin, albumen, 
and extractive."* Long ago Magendie proved that it was im- 
possible to sustain health on any single alimentary substance; 
but this does not apply to protein compounds, for Hammond 
thinks it "fully proven that before the general health becomes 
injured by a too long exclusive use of albumen, that enough of 
this substance can be assimilated to repair the waste of tissues 
and support the respiratory functions."t This may be so in the 
case of a robust experimentalist, and, in many instances, where 
the constitution is not shattered, and the digestive organs weak- 
ened, but in diabetes, where the vital powers are generally at 
their lowest ebb, shimmed milk — which does not contain all the 
substances which enter into the composition of the tissues of 
the body — will hardly be found sufficient to sustain life. The 
fact is, we can lay down no special dietary for this disorder, as 
almost every case must be a law to itself. We know that there 
is a natural tendency to asthenia, which must be obviated by a 
judicious regimen, but of the necessities in each case the prac- 
titioner alone must be the judge. The rule laid down by Dr. 
Honkin is that the skimmed milk diet "must be persevered in, 
methodically and exclusively, until convalescence is cstablished. v 
That method, in its administration, is absolutely necessary to 
success, appears to have been recognized by ancient authors, 
for Paulus iEgiueta,f (who copies from Euffus and Oribasius) 
says: "He who drinks milk ought to abstain from all other 
food until it be digested and pass downward. It is best, there- 
fore, to drink it in the morning, newly milked, and to take no 
food after it, nor any hard exercise, because this would make 
it turn acid. But it is better to walk about gently and rest 
between, without sleeping." The italics are mine; and I would 
here remark that the time of its administration is of much con- 
sequence. The nutritive and restorative influence of milk is 
greater when taken early in the morning, because the absorb- 
ent system at this period is in its most active state; besides, a 
quantity of the fluid can then be borne without inconveuience r 
which at any other time would be followed by the most painful 
oppression. I must take exception to that part of the rule 

* Hammond, Physiolog. Mem., p. 103. 

t Ibid, p. 104. 

X Vol. 1, p. 154, sect, lxxxvii. 



MEDICAL AKD SURGICAL ESSAYS. 199 

which requires the milk to be used "exclusively until conva- 
lescence is established." Without a judicious employment of 
other dietetics, I fear that mauy cases (particularly those of a 
tuberculous nature) 'would sink under that general exhaustion 
of the vital powers which it is our object and duty to avert. 
Therefore, while acknowledging the remedial value of skimmed 
milk in the treatment of diabetes, I am forced to the conclu- 
sion that there are many cases like the following, which will 
show the necessity of not depending upon it as an exclusive diet. 
Mrs. A. B., a native of Philadelphia, fifty years of age, of 
medium height, florid complexion, and nervo-sanguine tem- 
perament ; has never been robust, having suffered from spinal 
irritation, and from repeated attacks of gout in the stomach. 
Ever since 18G9 her health'has been failing, owing to mental 
excitement and other causes ; but it was not until the middle 
of December, 1S70, that a marked change was noticed in her 
appearance. Most of her symptoms were then ascribed to 
change of life, and to a vegetable diet, to which she had exclus- 
ively confined herself for one or two years. About February, 
1871, her emaciation became quite perceptible, her appetite and 
thirst were inordinately increased, and by the middle of March 
all the symptoms of diabetes were developed. She was consid- 
erably troubled with dyspepsia, headache, nervous tremors, pal- 
pitation of the heart, and dimness of sight. Her bowels were 
constipated or irregular, and the renal secretion excessive. 
Eight to ten pints of pale urine, possessing the characteristic 
apple odor, of a specific gravity not below 1040, were secreted 
daily. She complained of constant aching pains in her loins, 
and in anterior surface of thighs, and of a sense of sinking, or 
"falling to pieces," as she expressed it. Her appetite now be- 
came voracious, and her thirst intense, her memory more im- 
paired, and eyesight so defective that she frequently exclaimed, 
" I believe I am going blind ; I cannot see." These symptoms 
were accompanied by fits of despondency, a constant fear of 
impending evil, and extreme general debility. On testing 
her urine by Tromuer's, Moore's, and Luton's tests, au abund- 
ance of sugar was discovered. Microscopic examination re- 
vealed the presence of iunumerable crystals of oxalate of lime 
and epithelium — rather a rare occurrence — which may account 
for the intense hypochondriasis, pain in the loins, and distress- 
ing sense of fatigue in this case. Having satisfied myself of 
the nature of her disease, I determined to try the effect of 



200 



MEDICAL AND SURGICAL ESSAYS. 



skimmed milk, so highly recommended by Dr. Arthur Scott 
Donkin, in au article " On a purely milk diet in diabetes, mel- 
litus," &c. (London Lancet, January, 1870.) Accordingly, on 
Monday, the 20th March, 1871, I directed six pints of milk 
(carefully skimmed and previously warmed) to be taken in 
divided doses every three hours, and prohibited all other food. 
The result was peculiarly gratifying, as her hunger and thirst 
were diminished during the day, and she felt more comfortable. 
From this date the accompanying table will show the daily 
amount of urine secreted, its specific gravity, and quantity of 
solids, so that 1 shall make but few remarks upon the progress 
of the case : 



Mar. 
Mar. 

Mar. 

Mar. 

Mar. 

Mar. 

Mar. 

Mar. 

Mar. 

April 

April 

April 

April 

April 

April 

April 

April 

April 

April 

April 

April 

April 

April 

April 

April 

April 

April 

April 

April 

April 



20, 1871 
21, 1871 
22, 1871 
23, 1871 
24, 1871 
25, 1871 
20, 1871 
27, 1871 
28,1871 
29, 1871 
30,1871 
31, 1871 
1, 1871 
2, 1871 
3, 1871 
4, 1871 
5, 1871 
6, 1871 
7, 1871 
8, 1871 
9, 1871 
10, 1871 
11,1871 
12, 1871 
13, 1871 
14, 1871 
15, 1871 
16, 1871 
17, 1871 
18, 1871 
19, 1871 
20, 1871 
21, 1871 



Quantity. 



Specific 
gravity. 



1040 
1017 
1018. 
1020 
1030 
1034 
1025 
1028 
1030 
1032 
1032 
1026 
1029 
1028 
1026 
1032 
1032 
1032 
1020 
1022 
1032 
1032 
1032 
1032 
1032 
102S 
1030 
1032 
1026 
1026 
1022 
1022 
1024 



SoliiU. 



Oz. dr. gr. 



9 



58 



Grains. 
2638 
657 
96 
164 
404 
320 
340 
320 
105 
260 
240 
278 
120 
135 
115 
200 
314 
294 
297 
601 
476 
450 
377 
340 
309 
473 
590 
444 
314 
279 
420 
398 
300 



MEDICAL AND SURGICAL ESSAYS, 



201 



Quantity. 



Specific 
gravity. 



April 22, 1871 
April 23, 1871 
April 24, 1871 
April 25, 1871 
April 26, 1871 
April 27, 1871 
April 28, 1871 . 
April 29, 1871 . 
April 30, 1871 . 
May 1, 1871 . 
May 2,1871. 



May 
May 
May 

May 
May 
May 
May 
May 



3, 1871 . . . 

4,1871 ... 

5,1871 ... 

6, 1871 . . . 

7, 1871 . . . 

8,1871 ... 

9,1871 ... 
10, 1871 . . . 
May 11,1871 ». 
May 12, 1871 . . . 
May 13, 1871 . . . 
May 14,1871 ... 
May 15,1871* .. 
May 16, 1871 . . . 
May 17, 1871 . . . 
May 18, 1871 . . . 
May 19,1871 .. 
May 20, 1871 . . . 
May 21, 1871 . . . 
May 22, 1871 . . . 
May 23,1871 ... 
May 24, 1871 . . . 
May 25, 1871 . . . 
May 26, 1871 . . . 
May 27, 1871 . . . 
May 28, 1871 . . . 
May 29, 1871 . . . 
May 30, 1871 . . . 
May 31,1871 ... 



Oz. dr. gr 



1032 

1022 

1018 

1024 

1026 

1020 

1014 

1022 

1016 

1016 

1024 

1024 

1022 

1024 

1026 

1022 

1020 

1020 

1020 

1020 

1020 

1020 

1020 

1014 

1016 

1020 

1020 

1018 

1022 

1016 

1018 

1022 

1026 

1016 

1026 

1034 

1032 . 

1032 

1032 

1032 



125 
310 



332 

298 



165 
265 
220 
410 
400 
606 
220 
j 506 

460 
460 
350 
356 
116 

4 gr. per oz. 

5 gr. per oz. 

6 gr. per oz. 
4 gr. per oz. 
4 gr. per oz. 
6 gr. per oz. 
4 gr. per oz. 

4 gr. per oz. 

5 gr. per oz. 
5 gr. per oz. 

4 gr. per oz. 

5 gr. per oz. 

3 gr. per oz. 

4 gr. per oz. 
3 gr. per oz. 
3 gr. per oz. 
3 gr. per oz. 



*From the 15th to the 31st of May the quantity of sugar was obtained by making 
use of fresh yeast to establish vinous fermentation. 

On Tuesday, the 21st Marcit, six pints of milk were adminis- 
tered, and the urine was reduced in quantity (in twenty-four 
hours) from six pints three ounces, specific gravity 1010, con : 
taining over nine ounces of solids, to four pints thirteen ounces, 



202 MEDICAL AXD SURGICAL ESSAYS. 

specific gravity 1017, containing two ounces six drachms and 
thirty-six graius. During the day she had a slight attack of 
diarrhoea, and expressed distaste for the milk. 

March 22d. — Under the same diet the urine was reduced to 
two pints eight ounces ; specific gravity, 1018 ; solids, one ounce 
four drachms twenty-six grains. Skin clammy, pulse 98. She 
complained of headache, nausea, and debility. 

March 23d. — The improvement in the renal secretion contin- 
ued, but her strength was rapidly failing. She complained of 
headache, inability to make the slightest exertion, intense pain 
in loins and thighs, nausea, and increased amblyopia.* Pulse 
101. Both hunger and thirst had now completely abated, and 
the amount of urine passed in twenty-four hours amounted to 
but two pints fourteen ounces, specific gravity 1020 ; solids one 
ounce five drachms thirty-four grains. 

March 2±th. — Urine secreted, two pints five ounces; specific 
gravity, 1030 ; solids, two ounces two drachms and twenty- 
four grains. 

March 25th. — I found my patient so much exhausted that 1 
scarcely felt justified in pursuing further the exclusively milk 
diet, and, after consultation with a medical friend, I decided to 
give but fifty ounces of skimmed milk per diem, and to supply 
additional nutriment by a suitable proportion of beef-tea. 
Under this treatment she became stronger, and expressed herself 
as "feeling much better." One pint twelve ounces of urine 
were secreted; specific gravity, 1034. Pulse 94. 

From the 25th of March to 1st of April there was a. steady 
improvement in her symptoms. The renal secretion ranged 
from one pint eight ounces to two pints four ounces ; specific 
gravity from 102G to 1034. Her diet was varied occasionally 
with poached eggs, mutton, squab, spinach, and Camplin's bis- 
cuit. The oxylates disappeared from the urine under the use 
of nitro-hydrochloric acid in infusion of serpen taria, and with 
them went many of her distressing symptoms. On the whole, 
she appeared more cheerful and less weary; her eyesight had 
improved, and she felt generally more comfortable. On the 
29th March there was a copious deposit of uric acid. From the 
1st to the 7th of April the urine varied in quantity from one 

* It will be seen that the amblyopia did not cease upon the administration 
of animal food, (as it did in one of Griesiuger's patients,) neither did it follow 
the course observed by Le'corche', " I)e L' amblyopic Didb&ique," Gaz. Heb- 
dom., Nov., 1861. 



MEDICAL AND SURGICAL ESSAYS. 203 

pint eight ounces to two pints five ounces ; specific gravity from 
102G to 1032. 

April Sth. — Patient caught cold, and felt less well in conse- 
quence. She had a night-sweat, and complained of great de- 
bility. Urine, three pints nine ounces; specific gravity, 1022. 

April lGth. — Her night-sweats returned, but were promptly 
checked by sulphate of quinia combined with oxide of zinc. 
From this time until the Sth of May she continued to improve. 
Specific gravity of urine varied from 1018 to 1020. 

May Sth. — Not so well, and toward evening many of her old 
symptoms returned. The quantity of urine was much increased, 
though the specific gravity did not rise above 1024. This un- 
favorable change was probably brought about by the patient 
indulging in ice-cream containing corn-starch. As her strength 
had now improved sufficiently to justify a return to the exclus- 
ively skim-milk diet, I again placed her upon it, directing, as 
before, six pints daily, in divided doses; but on the 13th I was 
obliged to give her beef-tea, eggs, &c, as she complained of 
being unable to subsist upon the milk alone. 

From this time until the conclusion of this report (June 1, 
1S71) there was a daily improvement in all her symptoms. Her 
appetite is now good, her rest sound and natural. She has 
gained in flesh, (seven pounds during the period of treatment,) 
and though her urine is still glycosuria, the improvement in 
her health is so great that she expresses herself as feeling 
u perfectly well." 



CASE OF EROSION OF THE ENTIRE PENIS. 

(Compiled from hospital records.) 



By W. S. W. KtsCHENBEKGER, M. D., 

United States Navy. 



W. T. Park, seaman, native of Boston, Massachusetts, aged 
sixty-three years, was admitted into the Naval Hospital, Phil- 
adelphia, April 22, 1870, from the United States steamer Iro- 
quois, on account of " ulcer of the penis." Has been about 
twenty-five years in the naval service. His stature is about 
five feet ten inches, symmetrical, well developed ; he has the 
aspect of muscular strength and general robust health. His 
penis is reduced to a stump of about a half inch long, which 
is ulcerating. The record of the case in the hospital shows 
only that the ulcer was dressed with an aqueous solution of 
carbolic acid, and that it seemed to be healing slowly. 

May 20. — An unsuccessful attempt to pass a catheter was 
made and repeated June 13 and 27, under the influence of an 
anaesthetic. 

June 30. — Condition of patient unchanged. Dr. P. J. Hor- 
witz attempted the introduction of a catheter this morning, 
but failed. 

July 2. — Ulcer increasing slowly. Continue carbolic acid 
lotion. 

July 10. — Last night the patient had a severe chill followed 
by fever. 

R. Hydrarg. pil,, 

Jalapse pulv., aa gr. vi. 
Colocynth. ext. coiup., gr. iij. 
M. S. a. fit. pil. iij. Stat sumend. 

The bowels were freely moved. Pulse 100; tongue clean; 
condition of ulcer much the same. 

f>> Spts. ffitheris nitros., ^i. 
Ammonia; liq. acetat., ^iij. 
M. A tablespoonful every half hour. 

July 11. — Ulcer remains the same. The surrounding tissues 
are considerably inflamed and indurated; the inflammation 



MEDICAL AND SURGICAL ESSAYS. 205 

lias the appearance of erysipelas. Has slight fever this morn- 
ing ; bowels moved. Continue the mixture, and apply lead 
and opium wash to inflamed parts. 

July 12. — Inflammation subsiding; no fever; omit mixture. 

R. Quiniao sulph., grs. xxv. 
Ferri chlorid. tinct., 3i. 
Aquae, ?vi. 
M. A tablespoonful thrice daily. Port wine, ?ij. three times a day. 

July 14. — Some discoloration about the hip-joint ; complains 
of great soreness on attempting to walk. 
July 15. — Condition unchanged. Complains of want of sleep. 

R. Chloral hydrate, grs. xv. 
Aquae cinnamomi,'Jiij. 
M. ft. haust. s. s. To be repeated in half an hour. 

July 20. — Improving slowly; less discoloration of tissues (?); 
condition of ulcer remains the same ; complains of want of 
sleep. Chloral hydrate, grs. xx in solution at night; it seems 
to affect him very pleasantly. 

July 23. — Condition unchanged ; rather more pain. Chloral 
has delightful effect. 

July 25. — Not so well ; condition of parts about the same. 
Complains of pain in the right side, which extends from about 
the third lumbar vertebra to ensiform cartilage. Bowels regu- 
lar; tongue clean; appetite very poor ; pulse 90. 

R. Chloral hydrate, grs. xxx. 
Aquae cinnamomi, f 2 vi. 
M. ft. sol. One half at once, and the remainder in half an hour. 

Evening. — Continues to have very severe pain in side, which 
is greatly aggravated on the slightest motion of the body; 
about 3 o'clock p. m. took chloral hydrate, grs. xxx. Slept about 
half an hour. 

R. Morphias sulph. sol., tjij. 
Aq. camph., ^ij. 
M. S. a. One half at once, and in half an hour the remainder if necessary. 

July 20.— Has less pain in the side; appetite improving; 
morphine at night. 

July 27. — Condition of parts remains about the same; con- 
tinue lotion, 

August 2. — General condition improving ; ulcer and surround- 
ing parts unchanged; continue treatment. 

August 12. — Ulcer in groin becoming larger; is about one 



206 MEDICAL AND SURGICAL ESSAYS. 

aucl a half inches deep. [This is the first reference to the groin 
found in the record.] 

August 20. — Condition no better ; ulcer in groin steadily in- 
creasing. Generous diet with wine, quinine, and iron. A 
twenty-grain solution of nitrate of silver applied to ulcer of 
groin this evening. 

August 25. — Gradually becoming worse. 

R. Liq. sodse chlorin., |ij. 
Aquae, ^x. 
M. Apply with lint several times daily. Discontinue acid carbolic. 

September 2. — Condition about the same. Ulcer in groin in- 
creasing in size. This morning Professor S. D. Gross made an 
unsuccessful attempt to pass *a catheter. He looks upon the 
case as one of epithelioma, and recommends the same treatment 
to be continued. [The record does not state why efforts to pass 
a catheter were made. The flow of urine from the bladder was 
always free.] 

September 20. — Slight haemorrhage from the ulcer of groin 
last night, which was probably venous. Continue treatment. 

September 26. — Continues to have slight haemorrhages from 
the groin; condition otherwise unchanged. Continue treat- 
ment. 

[Surgeon Euschenberger succeeded Surgeon Horwitz in charge 
of the hospital October l.J 

October 6. — The patient declares that generally he feels pretty 
well, and that, until after the efforts to pass instruments into 
his bladder had been made, he never had trouble in micturition, 
and has very little, if any, now ; the act is most easily accom- 
plished by assuming an almost prone position, but as the parts 
in the vicinity of the outlet of the bladder are unavoidably 
bathed in urine at the time, it is always attended with discom- 
fort. The patient lies upon his back, the right side rather 
lower than the left, with the knees wide apart and slightly 
flexed to accommodate the increased size of the scrotum, the 
two diameters of which are estimated at not less than four and 
six inches. Its tissues are thickened and dense, and its weight 
is a source of discomfort, for the relief of which the patient 
carefully adjusts a cushion or pad beneath it after every change 
of position. The surface is generally dark-colored, with here 
and there a slightly reddish blush. The raphe is prominent, 
reddish, smooth, and extends to the extremity of the spongy 
portion of the penis, now not more than an inch in length. The 



MEDICAL AND SURGICAL ESSAYS. 207 

remnants of the corpora cavernosa are shorter, projecting above 
the skin of the pubis less than a half inch, so that the surface 
of the penil stump is irregularly beveled. This is caused by 
granulations of about an eighth of an inch in diameter, of a 
deep salmon-red color. The urethra, or rather the outlet from 
it, is an irregular opening of a half inch diameter, at the bottom 
of which may be seen a tiny pool of liquid, chiefly urine, rising 
and falling with the motions of the diaphragm. 

Whenever any inspection of the parts is attempted the 
patient wears an aspect of dread of pain, holding his expanded 
right hand in a- protecting way before thein, often saying he 
cannot bear the least touch. The fold of the right groin is 
occupied by an ulcerated cavity of an inch and a half deep, and 
two and a half long ; the edges of this opening are bounded by 
everted lips, about three-eighths of an inch wide, smooth on the 
side of the opening, but ragged on their outer edge. This lip 
might be compared to a flat pink braid trimming around a button 
hole. From this ulcer issues a bloody serum, and sometimes 
pure blood. The odor of the patient is that peculiarly disgust* 
ing cancerous stench which carbolic acid in this case does not 
entirely suppress. The thigh below the ulcer is swollen, red, 
and tender. 

The patient states that ten or twelve years ago he sailed from 
London on a merchant vessel, and after departure venereal sores 
appeared on his penis. On arriving at Adelaide, Australia, his 
condition required his admission into an English hospital. 
More than a third of the penis was amputated at the institu- 
tion ; and after some months he recovered. He shipped April 
29, 1868, on board the United States steamer Unadilla at Hong 
Kong, and was transferred to the United States steamer Iro- 
quois October 17. About a year afterward a rope fell from 
aloft, the end of which did not quite reach the deck, so that it 
rebounded, from its elasticity, and struck the extremity of the 
stump of his penis ; an ulcer followed, and he was admitted on 
the sick-list in November, 1869. 

Ulcers dressed with iodoform ; one grain of opium night and 
morning. 

October S. — Swelling of thigh increased ; loss of appetite; 
tongue clean; pulse 100. 

R. Liq. ammonite acetafc., ji'j- 
Spts. aether nitros., ^i. 
M. Cap. 5 SS - II- 2nda. h. 



208 MEDICAL AND SURGICAL ESSAYS. 

October 9. — Swelling increased; erysipelatous in appearance; 
pulse 110. 

Ferri tinct. chloric!., gtt. xx. Ter die surnend. 

October 10. — Pulse 90 ; condition of thigh unchanged ; per- 
sist. Iodoform and glycerine to thigh and ulcers. 

October 11. — Pulse 110; thigh very much swollen and in- 
flamed; obscure fluctuation below Poupart's ligament; appetite 
good — persist. 

R. CamphorsB pulv., 3ss. 
Hyclrarg. uug., ?ss. 
Belladon. ext., grs. x. 
Glycerine, 3i- 
M. ft. uug. liq. Smear over upper part of thigh. 

October 12. — Patient was placed under influence of a mixture 
of ether and chloroform, and an iucision made about 2| inches 
below Poupart's ligament, and two inches on inner side of 
median line of thigh, giving exit to about eight ounces of very 
foetid pus. Dressed with lead and opium wash on lint, covered 
with oiled silk. Eeaction from anaesthetic excellent; pulse 70; 
tongue clean ; appetite good. 

October 13. — Rested well ; pulse 70 ; tongue clean ; abscess 
discharges freely ; pus very foetid ; thigh is considerably swollen 
and red. Applied carbolic acid, 3i, aquae, Iviij, on lint, and 
dressed as before. 

October 15. — Removed a quantity of broken down tissue; 
discharge free ; thigh less swollen ; not so much inflamed; appe- 
tite poor. 

R. Potassii iodidi, 

Ammoniie muriat., aa 3i. 
C'inchoiue, tiuct. comp., ^iv. 

M. Cap. ^ss. q. q. 4 ta. h. Omit iron. 

October 17. — Appetite improved; no fever; tongue clean; 
inflammation of thigh rapidly subsiding; small amount of slough 
removed. Ulceration on penis improved ; persist. 

October 19. — Thigh about its natural size ; abscess free from 
slough; opening healing ; persist. 

October 26. — jSTo marked change in aspect of ulcers. Faradized. 

November 9. — Faradized daily for ten minutes since last note. 
Eedness is abated during the application of the electric cur- 
rent. Groin about the same; edges of ulcer very thin and 
serrated ; aspect changes daily. 

November 12. — Opening in groin covered with a dark gray 
slough. Faradized on alternate days. 



MEDICAL AND SUEGICAL ESSAYS. 209 

November 21. — Slight haemorrhage from groin ; ulcer increas- 
ing; that of penis about the same. 

December 1. — Considerable haemorrhage last night from the 
groiu ; opening steadily increasing in size. General treatment 
continued. 

December 8. — Patient's general condition improving. 

December 12. — Severe chill yesterday, followed by fever. 

December 13. — No return of chill. Erythematous blush over 
hypogastric region, (perfectly defined by a transverse straight 
line above,) thighs, and scrotum. 

December 14. — Spirits better ; erythematous blush nearly dis- 
sipated. 

December 15. — Edges of ulcer <3f groin bleeding, which dress- 
ing arrested. 

December 16. — No haemorrhage ; blush slight. 

December 17. — Blush has disappeared. 

December 18. — Considerable haemorrhage from edge of ulcer ; 
arrested by dressing. 

December 20. — Ulcer, illuminated by light reflected from a 
concave mirror, appears clean, except at bottom, where there is 
a dark unhealthy slough about two inches in breadth by one 
and a half deep. 

December 21. — Slight haemorrhage from edge of ulcer. 

December 22. — General health much improved. 

January 12, 1871. — There are two elevations about the size of 
a pea, about an inch below root of penis, and two papulae in pubic 
region, bearing the appearance of fresh implantations. 

January 17. — Ulcer not so clean. 

January 18. — Pain in dressing ; ulcer looks badly. 

January 19. — A thin, watery, offensive discharge, containing 
cheesy fioculi, from a small opening about an inch below the 
ulcer, which is painful while dressing. Carbolic acid, 3ij, to a 
pint of water. This dressing smarted for a short time. 

January 20. — Offensive odor of discharge corrected. 

January 22. — Faradization, which has been continued every 
two or three days, abandoned. Galvanized with thirty of 
Smee's cells ; no immediate effects observed. An hour after- 
ward complained of pain and stiffness in the surrounding parts. 

January 28. — A large quantity of haemato-purulent matter 
came away with the dressing. 

January 29. — Solution of permanganate of potassa placed 
under the bed to correct odor in the ward. 
14 M 



210 MEDICAL AND SURGICAL ESSAYS. 

• 

February 20. — Papulae before mentioned increasing in size ; 
two on the scrotum about to coalesce; several others observed 
on pubic region. 

March 1. — Yesterday the scrotum became painful and tender. 
At 9 o'clock p. m. attacked with severe nervous rigor, which 
lasted an hour. This was followed by swelling of the scrotum 
and a deep erythematous blush over it, the pubic region, and 
thigh. The line of demarkation on the abdomen well defined. 
Constipated ; bowels moved by Sedlitz powders. There is a 
furfuraceous condition of the forehead, temples, and ears with- 
out itching. Arseniate of soda. 

March 2. — Erythema extending; scrotal swelling increased. 

fj;. Liq. plumb, subacetat., 3i- 
Aqme, ^vi. 
M, Apply to erythematous parts. 

March 7. — Erythema has disappeared ; scrotal swelling dimin- 
ished. Ulceration of groin extending slowly. Several elevated 
ulcerations on the scrotum and hypogastric region ; appetite 
fair ; bowels regular ; sleeps well. 

March 15. — Surface of ulcer in groin foul and sloughy ; dis- 
charge foetid ; cedema of right foot. 

March 17. — (Edema of foot increasing ; ulcers extending. 

March 24. — Galvanization has been continued every second 
day. Complains of burning pains during and for an hour after 
the application. Hard, brawny swelling surrounds the ulcer in 
the groin ; integument red ; more pain. 

March 28. — (Edema of foot continues. Except one on the 
scrotum, which looks more healthy, the ulcers are spreading. 

April 5. — Ulceration at root of penis does not increase, but 
that in the groin is extending toward the crest of the ilium. 
A layer of gray pultaceous matter covers the bottom. Odor 
excessively foetid ; pain more severe; sleeps badly. Opii tinct., 
gtt. xx. H. S. S. 

April S. — Complains of great pain in groin and limb, which 
is much swollen. Thinks he passes less urine than formerly. 
Eb appetite; tongue coated. 

fy. Liq. ammonias acetat., ^iijss. 
% Spts. aetheris nitros., ^88. 

M. Cap. ^ss. q.q. 3 tra. h. At bedtime, opii tinct., gtts. xx. 

April 9. — Eo appetite; did not sleep; irritable. Limb much 
swollen ; edges of ulcer in groin excessively painful. 



MEDICAL AND SURGICAL ESSAYS. 211 

April 11. — Limb less swollen ; cavity of ulcer filled with an 
excessively foetid discbarge. Slept well. 

April 13. — Feels better. Slept all night and for three hours 
yesterday afternoon. 

April 21, — Removed a large lump of offensive matter from 
ulcer. 

April 25. — Leg and thigh diminished in size ; parts appear 
to be cleaner. 

May 1. — General condition better. Granulations are appear- 
ing in the large cavity ; discharge less ; appetite good. 

May 12. — Granulations in large cavity increasing. 

June 2. — Ulcer in groin seems to be gradually closing ; slight 
haemorrhage from it. Leg oedematous ; scrotum large as ever. 
Ulcers on hypogastric region increasing ; appetite good ; sleeps 
well. 

June 3. — Parts photographed. Galvanization, which has been 
used regularly on alternate days, suspended. Earth dressing 
applied morning and evening. 

June 14. — Dressing affords much comfort ; odor very much 
less. 

June 8. — On removing the dressing this morning, a number 
of maggots were discovered in the ulcers of the groin and 
abdomen. They were removed with forceps, and carbolic acid 
freely applied to the whole surface before re-applying the 
earth. 

June 10. — No maggots; carbolic acid applied previous to each 
earth dressing. 

June 12. — Ulcer in groin stationary ; patient comfortable. 

June 15. — Intense pain in leg and foot all night. Adminis- 
tered sol. morph. sulph., fij, and opii ext., gr. ij. Not until 
after the limb was faradized this morning was the pain 
relieved. 

June 10. — 

B> Soda? arseniatls sol., ^ss. 
Ferri vini amaii, f ^ss. 
M. A teaspoonful ten minutes after each meal. Suspend liq. ammonias 
acetat. 

June 18. — Appetite failing. Two ounces of port wine morning 
and evening, and a half-pint bottle of ale at dinner. 

June 19. — Discharge from small ulcer on scrotum shows under 
the microscope only pus corpuscles, but no epithelial scales or 
cells. 



212 jtfEDICAL ' AND SURGICAL ESSAYS. 

June 20. — Much pain in leg and foot last night. Opii ext. 
gr. ss. at bedtime. 

June 21. — Severe shooting pain in leg last night ; sleepless 
anorexia; bowels regular. Faradized. 

June 22. — Slept well;- less pain. Faradized. 

June 23. — Slept well without anodyne. 

June 25. — Eo change of condition. Found five maggots in 
ulcer. Carbolic acid applied prior to application of earth dress- 
ing. 

July 1. — About noon discovered arterial blood oozing from 
ulcer in groin, which was arrested by cold water, after a loss of 
about two ounces. In the evening feels more comfortable. 

July 2. — Slight oozing of blood from floor of large ulcer ; gran- 
ulations feeble ; less pain this a. m. About noon lost not less 
than two pounds of arterial blood from the groin,' at first in a 
jet ; arrested by cold water ; dressed with matico. 

July 3. — CEdema less ; has movement of ankle. Pulse SO, 
weak ; anorexia ; insomnia, but no restlessness. Face exsan- 
guine. 

July 5. — Insomnia; no pain; anorexia; pulse 72; skin moist; 
oedema less ; face pallid. 

R. Carnis extract!, 3i-- 
Capsici tiuct., fl"lxx. 
Aq. fervent., 
Vim porteiisis, iia ^iv. 
M. A wineglassful every four hours. . 

At 10 p. m. lost about two ounces of arterial blood from groin. 
Prostration great; pulse weak, 98; face pallid and pinched; 
lips blue. Removed earth; checked haemorrhage, with cold 
water, and dressed with carbolic acid. Frumenti spiritus, jss. 

July 6. — Eb return of haemorrhage. Isthmus between large 
and small ulcers in groin has sloughed away. Patient complains 
of excessive prostration. Packed the cavity with matico, and 
covered with earth dressing. 

July 7. — Treatment continued. 

July 8. — At 6 a. m. was discovered lying on his back, right 
leg flexed, with about four ounces of blood in the rubber sheet 
beneath him. He had died without notice of his ward com- 
panions or attendants. 

Autopsy. — By surgeon A. C. Rhoades, assisted by Assistant 
Surgeons M. L. Ruth, and J. T. Wells, eight hours after death. 
Body not emaciated ; rigor mortis marked. 



MEDICAL AND SURGICAL ESSAYS. 213 





Measurement of— 




Diseased 
limb. 


Sound 
limb. 




Inches. 
23 
21 
18 


Inches, 
18 


Circumference eight inches below anterior superior spine 


16 
13 







Head. — Not examined. 

Chest. — Old pleuritic adhesions on right side. Numerous 
small abscesses scattered through upper lobes of both lungs, 
which were of a dark color. At apex of right lung there were 
several small cretaceous bodies. 

Heart empty ; muscular fiber pale ; otherwise healthy. 

Abdomen. — Liver weighed 50 troy ounces; light yellow color; 
fatty; tissue softened; transverse diameter 12, and antero- 
posterior 7£ inches. 

Gall-bladder contained 2 ounces of bright yellow bile, and 
four gall-stones. 

Eight kidney, weight 4£ troy ounces, length 4|, and breadth 

2 iuches ; capsule healthy. In upper part of corticle portion 
was an abscess, the size of a hazel-nut, filled with pus. Several 
cysts in left kidney. Other viscera normal. 

The right external iliac artery and vein, just above Poupart's 
ligament, surrounded by a heterologous indurated deposit. 

Ulceration of groin 5 inches long, 2 inches wide, 1 inch deep 
at deepest part, with ragged excavated edges, extended in the 
direction of Poupart's ligament ; penis entirely eroded ; urethra 

3 inches long, obstructed by a large suppurating ulcer. Its 
seeming external orifice was a sinus, extending some distance 
alongside of it, which probably explains why attempts to pass 
a. catheter were unsuccessful. 

Scrotum much enlarged and thickened. Under the micro- 
scope sections of the inguinal ulcer appeared to consist of 
grayish broken-down tissue and pus-cells; no epithelial cells 
were observed. 

Remarks.— The hospital record of this case is not as satisfactory 
as it might have been had its commencement been more fully 
noted. It is regretted that there is no professional testimony 
as to the condition of the penil stump at the time of his last 
enlistment in the navy. The officer whose duty it was to 



214 MEDICAL AKD SURGICAL ESSAYS. 

inspect the person of this man, when he shipped at Hong Kong 
in 1868, floes not remember whether he had lost any part of the 
penis, but presumes he would have recollected such deficiency 
in any recruit passed by hiin. 

The date of first appearance of disease in the groin is uot 
recorded. 

The patient declared himself to be most comfortable when 
the atmospheric temperature of the ward was at from 55° to 
65° F.; when it was above that, he complained of heat. 

While in the hospital no complaint attracted attention to the 
chest, nor was there any symptom suggesting that the condi- 
tion of the respiratory apparatus was not perfect. This is 
worth notice, because ijost-mortem examination revealed " numer- 
ous small abscesses scattered through the upper lobes of both 
lungs." 

The patient stated that his sense of erections was as perfect 
after the almost entire obliteration of the penis as ever, and 
that sometimes in dreams he had sexual intercourse, which was 
accompanied in fact by seminal emissions. 

The administration of faradaic currents afforded comfort. 
The first applications were followed by marked decrease in the 
size of the scrotal swelling, and afforded relief by reducing its 
weight. They were made on alternate days during ten minutes, 
from the 26th of October, 1870, till January 22, 1871, almost 
three months. Kidder's apparatus, with two of Smee's cells, was 
used. 

A galvanic current from thirty cells of Smee's battery, manu- 
factured by Kidder, was substituted for faradization, and con- 
tinued on alternate days during four months. At first but 
fifteen cells were used ; afterward thirty were employed. 

The earth dressing consisted of the clayey soil of the hos- 
pital grounds, (which was carefully dried, ground, and passed 
through a No. 20 sieve,) thickly dusted in and over the diseased 
parts. A paste "of the same material and water was spread upon 
strips of blue paper, such as that used in preparing Sedlitz 
powders, with which the whole was covered. This is in accord- 
ance with the mode of earth-dressing followed by Dr. Addinell 
Hewson, of the Pennsylvania Hospital. He saw this case. The 
discharges being very free, and micturition being effected only 
in a prone posture, it was necessary to renew the dressings 
night and morning. Great abatement of stench and much com- 
fort to the patient are clearly ascribable to this dressing. At 



MEDICAL AND SURGICAL ESSAYS. 215 

the same time a very ill-conditioned stump of an amputated finger 
was treated in the manner above described, with entirely satis- 
factory result. About a half dozen dressings, at intervals of 
three or four days, completed the cure, although it was conjec- 
tured when the patient entered the hospital that a second ampu- 
tation would be required. This quality or property renders the 
use of matico preferable to that of most haemostatics. 

Coarsely powdered matico leaves, moistened into a pasty 
consistence with water, lightly packed in the inguinal ulcer, 
was promptly followed by arrest of haemorrhage. This paste 
always came away in a single mass, leaving the ulcerated cavity 
free from every particle of the matico. This quality or prop- 
erty renders the use of matico preferable to that of most hae- 
mostatics. 

The disease seemed to spread by new implantations on the 
apparently sound skin. There was first seen a tiny red spot upon 
which, in the course of a day, a minute vesicle, not more than 
a twentieth of an inch in diameter, formed. In the course of 
twenty-four hours this bursted, leaving an excavation. Around 
it other vesicles appeared and followed the same course. At 
the end of ten or twelve days there was a hemispherical mass 
a quarter of an inch in diameter with a strawberry-like surface, 
upon which vesiculization went on, but more and more slowly 
as the disease advanced. None healed. 



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